Provider Demographics
NPI:1275634396
Name:MCPHERSON, GREG (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
Last Name:MCPHERSON
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 1:3241 RUE ROYALE
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-8225
Mailing Address - Country:US
Mailing Address - Phone:636-493-1960
Mailing Address - Fax:636-493-1963
Practice Address - Street 1:3241 RUE ROYALE
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-8225
Practice Address - Country:US
Practice Address - Phone:636-493-1960
Practice Address - Fax:636-493-1963
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20671223G0001X
MO2009007429122300000X
IL019.028099122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist