JESSE R GRAY DDS PA (NPI# 1578001616) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578001616 |
| Entity Type | Organization |
| Organization Name | JESSE R GRAY DDS PA |
| Other Organization Name | NORTHWEST ORTHODONTICS |
| Practice Address |
3119 E Mission Blvd Fayetteville AR 72703-6617 |
| Practice Telephone | 4795214181 |
| Practice Fax Number | 4795210442 |
| Mailing Telephone | 4795214181 |
| Mailing Fax Number | 4795210442 |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-09 |
| Authorized Official Name | DR. JESS R GRAY (OWNER) |
| Authorized Official Telephone | 4795214181 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
3427 | AR | Dental Providers |
| Other Name | Type Code |
|---|---|
| Northwest Orthodontics | Other Name - Individual/Organization |
| Street Address |
3119 E MISSION BLVD |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-6617 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972972685 | Trinity Orthodontics of Fayetteville LLC | Dentist | 719 Lanier Ave W Ste B, Fayetteville, GA 30214-7621 | 2015-09-23 |
| 1386048189 | Bethel Burris Oliver Pllc | Dentist | 2901 Zion Rd, Fayetteville, AR 72703-5007 | 2014-10-22 |
| 1083957351 | Gateway Ventures LLC | Dentist | 3782 N Front St, Suite 1, Fayetteville, AR 72703-5128 | 2013-04-04 |
| 1780995449 | Gregory J Stock | Dentist | 404 E Genesee St, Fayetteville, NY 13066-1503 | 2010-06-28 |
| 1003019845 | Dana Thi Tang | Dentist | 2997 Hope Mills Rd Ste C, Fayetteville, NC 28306-8349 | 2007-06-08 |
| 1326256066 | Eric J. Echols | Dentist | 102 Pavilion Pkwy, Suite 14, Fayetteville, GA 30214-4056 | 2007-05-18 |
| 1033325436 | Darrin Storms D.d.s., C.a.g.s., P.a. | Dentist | 4102 N Mall Ave Ste 101, Fayetteville, AR 72703-4929 | 2007-05-15 |
| 1962623819 | J. Spencer Boley | Dentist | 4501 W Wedge Dr, Fayetteville, AR 72704-7532 | 2007-05-01 |
| 1992864375 | Michael W Granger | Dentist | 745 Bradley Dr, Fayetteville, GA 30214-2030 | 2006-12-08 |
| 1922166610 | Bill Pickard, Dds, Ms, Pa | Dentist | 3533 N Shiloh Dr Ste 3, Fayetteville, AR 72703-5317 | 2006-12-05 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
Please comment or provide details below to improve the information on JESSE R GRAY DDS PA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.