NPIMap

Organization Active NPI

John I Gray III PSC

  • Oral and Maxillofacial Surgery (Dentist)
  • Mt Sterling, KY
National Provider Identifier
1184772774
Registry record updated Oct 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
4210 Issued in KY
Legal business name
JOHN I GRAY III PSC
Practice address
25 E High St
Mt Sterling, KY 40353-1267
Phone
(859) 498-6204
Fax
(859) 498-6205
NPI assigned
Jan 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2022

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

Authorized official

Name
Dr. John I Gray III, DMD
Title
President
Phone
(859) 498-6204

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 4210 KY Primary

Addresses

Primary practice location

25 E High St
Mt Sterling, KY 40353-1267

Mailing address

25 E High St
Mt Sterling, KY 40353-1267
Phone (859) 498-6204

Other identifiers 6

IdentifierTypeStateIssuer
60038353MedicaidKY
61941258MedicaidKY
64180185MedicaidKY
60002284MedicaidKY
64942584MedicaidKY
65911877MedicaidKY

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666915200000",
    "number": "1184772774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 E HIGH ST",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403531267",
            "telephone_number": "859-498-6204",
            "fax_number": "859-498-6205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 E HIGH ST",
            "city": "MT STERLING",
            "state": "KY",
            "postal_code": "403531267",
            "telephone_number": "859-498-6204",
            "fax_number": "859-498-6205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN I GRAY III PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "I",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "859-498-6204",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "KY",
            "license": "4210",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60038353",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "61941258",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64180185",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60002284",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64942584",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65911877",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mt Sterling, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; 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.