Provider Demographics
NPI:1871813857
Name:GRAY, BRIAN M (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:GRAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 NICOLLET AVENUE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55420-2284
Mailing Address - Country:US
Mailing Address - Phone:952-541-2888
Mailing Address - Fax:952-541-2889
Practice Address - Street 1:8600 NICOLLET AVENUE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:MN
Practice Address - Zip Code:55420-2284
Practice Address - Country:US
Practice Address - Phone:763-585-8700
Practice Address - Fax:763-585-8704
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND128051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice