Provider Demographics
NPI:1326711771
Name:VESTA, GREGG II (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:VESTA
Suffix:II
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 1:7400 N LAMAR BLVD APT 2323
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-2477
Mailing Address - Country:US
Mailing Address - Phone:682-597-3705
Mailing Address - Fax:
Practice Address - Street 1:2726 E BUSINESS 190 STE 112
Practice Address - Street 2:
Practice Address - City:COPPERAS COVE
Practice Address - State:TX
Practice Address - Zip Code:76522-2526
Practice Address - Country:US
Practice Address - Phone:254-987-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice