Provider Demographics
NPI:1063662195
Name:OFFENBURGER, GREG L (DDS)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:L
Last Name:OFFENBURGER
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 1:1495 MORSE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6478
Mailing Address - Country:US
Mailing Address - Phone:614-268-4730
Mailing Address - Fax:
Practice Address - Street 1:1495 MORSE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-6478
Practice Address - Country:US
Practice Address - Phone:614-268-4730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT48192Medicare UPIN