Provider Demographics
NPI:1003262940
Name:GREGORY, DARNELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:DARNELL
Middle Name:
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 CHRISTENBURY PKWY STE 40
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-0261
Mailing Address - Country:US
Mailing Address - Phone:704-264-0253
Mailing Address - Fax:
Practice Address - Street 1:8815 CHRISTENBURY PKWY STE 40
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-0261
Practice Address - Country:US
Practice Address - Phone:704-264-0253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1001584122300000X
SCDGD.10229122300000X
NC134961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist