| John I. Gray, Iii, Psc | |
|
1303 W Lexington Ave Winchester KY 40391-3100 | |
| (859) 744-0677 | |
| (859) 745-4466 |
| Full Name | John I. Gray, Iii, Psc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 1303 W Lexington Ave, Winchester, Kentucky |
| Authorized Official Name and Position | John I Gray (OWNER) |
| Authorized Official Contact | 8597440677 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| John I. Gray, Iii, Psc 1303 W Lexington Ave Winchester KY 40391-3100 Ph: (859) 744-0677 | John I. Gray, Iii, Psc 1303 W Lexington Ave Winchester KY 40391-3100 Ph: (859) 744-0677 |
| NPI Number | 1790763258 |
|---|---|
| Provider Enumeration Date | 01/05/2006 |
| Last Update Date | 11/22/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790763258 | NPI | - | NPPES |
| 61941274 | Medicaid | KY | |
| 64042104 | Medicaid | KY | |
| 65911885 | Medicaid | KY | |
| 60042108 | Medicaid | KY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 4210 (Kentucky) | Primary |
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