Tyson N. Gray, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3799 Issued in ID

Practice address

813 Stilson Rd. Suite B
Millennium Family Dental Boise LLC
Boise, ID 83703

Phone

(208) 342-4644

Fax

(208) 888-2094

NPI assigned

Oct 31, 2006

Last updated

Dec 30, 2014By 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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

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

State licenses

Practice roles

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.

• Gray Team LLC

  dba Parkway Dental

  • General Practice Dentistry
  • Boise, ID
  • NPI 1922489673
  Authorized official Same address or phone
• Stilson Dental Partnership PLLC

  • General Practice Dentistry
  • Boise, ID
  • NPI 1669984902
  NPD (past) Authorized official
• Millennium Family Dental - Boise LLC

  • General Practice Dentistry
  • Boise, ID
  • NPI 1104925064
  NPD (past)
• Northview Dental Partnership LLC

  dba Parkway Dental at Northview

  • General Practice Dentistry
  • Boise, ID
  • NPI 1972023398
  NPD (past)

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419897600000",
    "number": "1659457885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1848 MILLENIUM WAY",
            "city": "MERIDIAN",
            "state": "ID",
            "postal_code": "836421510",
            "telephone_number": "208-888-2026",
            "fax_number": "208-888-2094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "813 STILSON RD. SUITE B",
            "address_2": "MILLENNIUM FAMILY DENTAL BOISE LLC",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83703",
            "telephone_number": "208-342-4644",
            "fax_number": "208-888-2094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "TYSON",
        "middle_name": "N.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2014-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806871400",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jody Gray, LCSW
• Jon R. Gray, D.C.
• Kenton Andrew Gray, BS, MC, LPC
• Laura Gray, MS, LPC
• Molly Elizabeth Gray, PT, DPT
• Nichole Grayson, RPSGT
• Greater Mind Integration, PLLC
• Brittney Greco
• Deborah Jane Green-Colby, LMSW
• Brady Green

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2014; 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.