Gray Team LLC

NPI #1922489673 in Boise, Idaho

Provider Information

NPI Number: 1922489673
Entity Type: Organization
Organization Name: Gray Team LLC
Primary Specialty: Dentist - General Practice
Enumeration Date: Jun 17, 2015
Last Updated: Jun 30, 2015

Practice Location

Address: 813 N STILSON RD
Address 2: STE:B
City: Boise
State: Idaho
ZIP Code: 83703-5119
Phone: (208) 342-4644

Authorized Official

Name: DR. TYSON GRAY, D.M.D
Title: OWNER
Phone: (208) 342-4644

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist - General Practice — General Practice	1223G0001X	Primary

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