Provider Demographics
NPI:1346318664
Name:KNOX, GREGORY S (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:S
Last Name:KNOX
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 1:1005 S 76 STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4684
Mailing Address - Country:US
Mailing Address - Phone:402-391-9300
Mailing Address - Fax:
Practice Address - Street 1:1005 S 76 STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4684
Practice Address - Country:US
Practice Address - Phone:402-391-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEN42001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47054703000Medicaid