Provider Demographics
NPI:1225101421
Name:MCCUNE, GREGORY T (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:T
Last Name:MCCUNE
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 1:8865 BRECKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BRECKSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44141-1931
Mailing Address - Country:US
Mailing Address - Phone:440-526-2123
Mailing Address - Fax:440-526-2124
Practice Address - Street 1:8865 BRECKSVILLE RD
Practice Address - Street 2:
Practice Address - City:BRECKSVILLE
Practice Address - State:OH
Practice Address - Zip Code:44141-1931
Practice Address - Country:US
Practice Address - Phone:440-526-2123
Practice Address - Fax:440-526-2124
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice