Provider Demographics
NPI:1225340375
Name:DUFFNER, GREGORY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:DUFFNER
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 1:18040 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1606
Mailing Address - Country:US
Mailing Address - Phone:708-798-6868
Mailing Address - Fax:708-798-6988
Practice Address - Street 1:18040 PARK AVE
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1606
Practice Address - Country:US
Practice Address - Phone:708-798-6868
Practice Address - Fax:708-798-6988
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0197821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice