Provider Demographics
NPI:1063666832
Name:GARY T GREGG, DDS PS
Entity Type:Organization
Organization Name:GARY T GREGG, DDS PS
Other - Org Name:GREGG DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GREGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-750-1385
Mailing Address - Street 1:700 N DEVINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-6964
Mailing Address - Country:US
Mailing Address - Phone:360-750-1385
Mailing Address - Fax:
Practice Address - Street 1:700 N DEVINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-6964
Practice Address - Country:US
Practice Address - Phone:360-750-1385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-06
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA600 477 520261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental