Active NPI
Edward Wyatt Gray, DDS
- Dentist
- San Diego, CA
National Provider Identifier
1811007677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 31272
- Practice address
- 1776 Grand Avenue
San Diego, CA 92109 - Phone
- (858) 270-7540
- Fax
- (858) 270-3428
- NPI assigned
- Aug 30, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 31272 | CA | Primary |
Addresses
Primary practice location
1776 Grand Avenue
San Diego, CA 92109
Mailing address
1776 Grand Avenue
San Diego, CA 92109
Phone (858) 270-7540
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD031272 | Other | CA | DEPT OF CONSUMER AFFAIRS |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31272 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1811007677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1776 GRAND AVENUE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92109",
"telephone_number": "858-270-7540",
"fax_number": "858-270-3428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1776 GRAND AVENUE",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92109",
"telephone_number": "858-270-7540",
"fax_number": "858-270-3428"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAY",
"first_name": "EDWARD",
"middle_name": "WYATT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-30",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "31272",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF CONSUMER AFFAIRS",
"identifier": "DD031272",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.