Provider Demographics
NPI:1093866956
Name:KAREM, GREGORY PHILLIP (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PHILLIP
Last Name:KAREM
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 1:4040 DIXIE HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3875
Mailing Address - Country:US
Mailing Address - Phone:502-448-8354
Mailing Address - Fax:502-448-4708
Practice Address - Street 1:4040 DIXIE HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3875
Practice Address - Country:US
Practice Address - Phone:502-448-8354
Practice Address - Fax:502-448-4708
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY43861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty