Jonathan Russell Gray, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2096 Issued in ND

Practice address

4344 20TH Ave S
Fargo, ND 58103-7436

Phone

(701) 239-5969

NPI assigned

Nov 30, 2007

Last updated

Aug 19, 2011By 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

Enrolled in ND

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Oral SurgeryAlso: Maxillofacial Surgery

Education

University of Southern California Keck School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Face and Jaw Surgeons PCGroup PAC ID 1153311881, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Bismarck, ND
  • NPI 1184667305
  Medicare reassignment Care Compare group NPD
• Face & Jaw Surgeons, PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Dickinson, ND
  • NPI 1730897026
  NPD
• Face and Jaw Surgeons PC

  • Oral and Maxillofacial Surgery (Dentist)
  • Fargo, ND
  • NPI 1295804300
  NPD

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313712000000",
    "number": "1508048521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4344 20TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581037436",
            "telephone_number": "701-239-5969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4344 20TH AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581037436",
            "telephone_number": "701-239-5969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JONATHAN",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-30",
        "last_updated": "2011-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "ND",
            "license": "2096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rhonda Gravalin
• Dylan Graves, MD
• Stephanie Lynne Gravning, MD
• Brittney Gray
• Holly Gray
• Kathryn Gray, PA-C
• Leslie Gray, RAC, RN, BSN
• Great Kids Therapy, LTD
• Great Kids Therapy, LTD.
• Great Plains Periodontics, PC

• Oral and Maxillofacial Surgery (Dentist) in Fargo, ND
• Providers in Fargo, ND by specialty
• Oral and Maxillofacial Surgery (Dentist) in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.