Provider Demographics
NPI:1013012350
Name:GARRO, GREGORY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:L
Last Name:GARRO
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 1:3525 N 147TH ST
Mailing Address - Street 2:SUITE 213
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8262
Mailing Address - Country:US
Mailing Address - Phone:402-493-8900
Mailing Address - Fax:402-933-2957
Practice Address - Street 1:3525 N 147TH ST
Practice Address - Street 2:SUITE 213
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8262
Practice Address - Country:US
Practice Address - Phone:402-493-8900
Practice Address - Fax:402-933-2957
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5751122300000X
IA7490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist