Provider Demographics
NPI:1003525833
Name:GREGORY, JAMES ELLIOTT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ELLIOTT
Last Name:GREGORY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4248 WIREGRASS RD
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-7800
Mailing Address - Country:US
Mailing Address - Phone:803-487-1485
Mailing Address - Fax:
Practice Address - Street 1:1812 WALLACE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4515
Practice Address - Country:US
Practice Address - Phone:843-571-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.103711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice