Randi Kennedy Gray, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7056 Issued in OK

Practice address

504 E Cherokee Ave
Sallisaw, OK 74955

Phone

(918) 774-4369

NPI assigned

May 23, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Randi Kennedy Gray Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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 and National Provider Directory roles.

• Randi Kennedy Gray, D.D.S., PLLC

  • Dental Clinic/Center
  • Sallisaw, OK
  • NPI 1346735594
  NPD Authorized official

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

{
    "created_epoch": "1527033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1841781002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 E CHEROKEE AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "749554842",
            "telephone_number": "918-774-4369",
            "fax_number": "918-776-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 E CHEROKEE AVE",
            "city": "SALLISAW",
            "state": "OK",
            "postal_code": "74955",
            "telephone_number": "918-774-4369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "RANDI",
        "middle_name": "KENNEDY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-23",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OK",
            "license": "7056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RANDI",
            "last_name": "GRAY",
            "middle_name": "KENNEDY",
            "prefix": "DR.",
            "credential": "D.D.S.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cynthia Lynn Glander, D.PH.
• Hunter Linda Godfrey
• Mika Goff
• Ashley Yoanna Gonzalez
• Grand Lake Medical and Wellness Corp
• Megan Nicole Green, PTA
• Tffany Leigh Green
• David Griffin
• Denise Griffin, CADC, ICADC,
• Rachel Grubbs, DO

• General Practice Dentistry in Sallisaw, OK
• Providers in Sallisaw, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; 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.