Provider Demographics
NPI:1225015837
Name:CANNEY, GREGORY B (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:B
Last Name:CANNEY
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 1:2417 MCGUIRE BLVD
Mailing Address - Street 2:DENTAL CLINIC
Mailing Address - City:MCGUIRE AFB
Mailing Address - State:NJ
Mailing Address - Zip Code:08641
Mailing Address - Country:US
Mailing Address - Phone:609-754-2886
Mailing Address - Fax:609-754-3696
Practice Address - Street 1:2417 MCGUIRE BLVD
Practice Address - Street 2:DENTAL CLINIC
Practice Address - City:MCGUIRE AFB
Practice Address - State:NJ
Practice Address - Zip Code:08641
Practice Address - Country:US
Practice Address - Phone:609-754-2886
Practice Address - Fax:609-754-3696
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA167131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice