Provider Demographics
NPI:1093790461
Name:WATERS, GREGORY BODE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BODE
Last Name:WATERS
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 1:8850 RALSTON RD
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-2248
Mailing Address - Country:US
Mailing Address - Phone:303-420-3233
Mailing Address - Fax:303-420-3234
Practice Address - Street 1:8850 RALSTON RD
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-2252
Practice Address - Country:US
Practice Address - Phone:303-420-3233
Practice Address - Fax:303-420-3234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8157122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist