Provider Demographics
NPI:1164526521
Name:APOSTLE, GREGORY BLAKE
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:BLAKE
Last Name:APOSTLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 MONTGOMERY DR
Mailing Address - Street 2:#210
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404
Mailing Address - Country:US
Mailing Address - Phone:707-542-4746
Mailing Address - Fax:707-544-7041
Practice Address - Street 1:95 MONTGOMERY DR
Practice Address - Street 2:#210
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404
Practice Address - Country:US
Practice Address - Phone:707-542-4746
Practice Address - Fax:707-544-7041
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA42114OtherDENTAL LIC NUMBER