Provider Demographics
NPI:1033205018
Name:LAGE, GREGG L (DDS)
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:L
Last Name:LAGE
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 1:7475 DAKIN STREET
Mailing Address - Street 2:SUITE 335
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221
Mailing Address - Country:US
Mailing Address - Phone:303-427-4552
Mailing Address - Fax:
Practice Address - Street 1:7475 DAKIN STREET
Practice Address - Street 2:SUITE 335
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221
Practice Address - Country:US
Practice Address - Phone:303-427-4552
Practice Address - Fax:303-427-3840
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO51591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice