Provider Demographics
NPI:1013033935
Name:HUMMON, GREGORY ALLAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLAN
Last Name:HUMMON
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:555 S OLD WOODWARD AVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6658
Mailing Address - Country:US
Mailing Address - Phone:248-644-5400
Mailing Address - Fax:248-644-4954
Practice Address - Street 1:555 S OLD WOODWARD AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6658
Practice Address - Country:US
Practice Address - Phone:248-644-5400
Practice Address - Fax:248-644-4954
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI153271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics