Provider Demographics
NPI:1033229042
Name:GREGORY, DONALD G (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:G
Last Name:GREGORY
Suffix:
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 1:975 NORTH CHURCH STREET
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303
Mailing Address - Country:US
Mailing Address - Phone:864-582-4308
Mailing Address - Fax:864-596-4492
Practice Address - Street 1:975 NORTH CHURCH STREET
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-582-4308
Practice Address - Fax:864-596-4492
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2410122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9992Medicaid
NC8990066Medicaid