Active NPI
Charles M Gray, D.D.S.
- Oral and Maxillofacial Surgery (Dentist)
- College Station, TX
National Provider Identifier
1205829041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Oral and Maxillofacial Surgery (Dentist)
- License
- 10404
- Practice address
- 1505 Emerald Plaza
College Station, TX 77845-1501 - Phone
- (979) 764-7101
- Fax
- (979) 764-7115
- NPI assigned
- Aug 26, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oral and Maxillofacial Surgery (Dentist) | 1223S0112X | 10404 | TX | Primary |
Addresses
Primary practice location
1505 Emerald Plaza
College Station, TX 77845-1501
Mailing address
1505 Emerald Plaza
College Station, TX 77845-1501
Phone (979) 764-7101
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110873003 | Medicaid | TX | |
| 813315 | Other | TX | UNITED CONCORDIA |
| 84V341 | Other | TX | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- Flagged The directory lists this NPI on an HHS exclusion list.
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10404 | TX | MD | Chiropractor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brazos Valley Oms PLLC | Oral and Maxillofacial Surgery | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125014400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283817600000",
"number": "1205829041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1505 EMERALD PLAZA",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778451501",
"telephone_number": "979-764-7101",
"fax_number": "979-764-7115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1505 EMERALD PLAZA",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778451501",
"telephone_number": "979-764-7101",
"fax_number": "979-764-7115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "CHARLES",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-26",
"last_updated": "2010-09-07",
"status": "A"
},
"taxonomies": [
{
"code": "1223S0112X",
"taxonomy_group": "",
"desc": "Dentist, Oral and Maxillofacial Surgery",
"state": "TX",
"license": "10404",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110873003",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "813315",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "84V341",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.