Provider Demographics
NPI:1023194107
Name:LECY, GREGORY GAYLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:GAYLE
Last Name:LECY
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 1:513 JEWETT ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MN
Mailing Address - Zip Code:56258-2645
Mailing Address - Country:US
Mailing Address - Phone:507-532-5789
Mailing Address - Fax:507-532-0686
Practice Address - Street 1:513 JEWETT ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MN
Practice Address - Zip Code:56258-2645
Practice Address - Country:US
Practice Address - Phone:507-532-5789
Practice Address - Fax:507-532-0686
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND93611223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics