Tanner Gray, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12322243-9926 Issued in UT

Practice address

49 MDG, 280 David L. Goldfein Street, BLDG 20
Holloman AFB, NM 88330

Phone

(575) 572-8099

NPI assigned

Apr 21, 2021

Last updated

Sep 18, 2025By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1758153600000",
    "number": "1114509080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 MDG, 280 DAVID L. GOLDFEIN STREET, BLDG 20",
            "city": "HOLLOMAN AFB",
            "state": "NM",
            "postal_code": "88330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 MDG, 280 DAVID L. GOLDFEIN STREET, BLDG 20",
            "city": "HOLLOMAN AFB",
            "state": "NM",
            "postal_code": "88330",
            "telephone_number": "575-572-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "TANNER",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-21",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "12322243-9926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hollynd Estrada, CRDH
• Heidi Fenton, MA
• George L Garcia, M.D.
• Kayla Garrett
• Tod Anthony Giglio, NP-C
• Chelsea Kahle Hanna, DO
• Josiah Hardin, DO
• Heather Harper
• Lillian Marie Hartley, CADC
• Daniel Haynie, DDS

• General Practice Dentistry in Holloman AFB, NM
• Providers in Holloman AFB, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.