Provider Demographics
NPI:1376765453
Name:GREGORY, SAMUEL THORNE JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:THORNE
Last Name:GREGORY
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:608-B WEST BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-4812
Mailing Address - Country:US
Mailing Address - Phone:910-892-8131
Mailing Address - Fax:910-892-8132
Practice Address - Street 1:608-B WEST BROAD STREET
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-4812
Practice Address - Country:US
Practice Address - Phone:910-892-8131
Practice Address - Fax:910-892-8132
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC42851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8993393Medicaid
NC8993393Medicaid