Provider Demographics
NPI:1326062985
Name:RUPP, GREGORY PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:PAUL
Last Name:RUPP
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:PO BOX 2437
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-2437
Mailing Address - Country:US
Mailing Address - Phone:910-754-8289
Mailing Address - Fax:910-755-3421
Practice Address - Street 1:4902 MAIN ST.
Practice Address - Street 2:SUITE A
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470
Practice Address - Country:US
Practice Address - Phone:910-754-8289
Practice Address - Fax:910-755-3421
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC55701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice