Matthew Lynn Gray, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901020479 Issued in MI

Practice address

3670 Woodward Ave
Suite 101B
Detroit, MI 48201-2455

Phone

(313) 355-1665

Fax

(313) 831-9064

NPI assigned

Sep 29, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442361600000",
    "number": "1043594773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2409 TUFTS AVE",
            "city": "ROYAL OAK",
            "state": "MI",
            "postal_code": "480674039",
            "telephone_number": "313-421-0079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3670 WOODWARD AVE",
            "address_2": "SUITE 101B",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482012455",
            "telephone_number": "313-355-1665",
            "fax_number": "313-831-9064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "MATTHEW",
        "middle_name": "LYNN",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-29",
        "last_updated": "2015-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901020479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Herman Gray, MD
• Katricia Gray
• Kimberly Gray
• Latisha Renee Gray, LPN
• Leslie R Gray
• Olanah Gray, PHARMD, RPH
• Renardo Gray, R.PH.
• Rizpah Marie Gray
• Shaun Gray, M.D.
• Stephanie L Gray

• General Practice Dentistry in Detroit, MI
• Providers in Detroit, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.