Provider Demographics
NPI:1386830636
Name:MERTES, GREGORY CHRISTOPHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHRISTOPHER
Last Name:MERTES
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 HUDSON DR STE 300
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4454
Mailing Address - Country:US
Mailing Address - Phone:330-655-5437
Mailing Address - Fax:330-655-5435
Practice Address - Street 1:5655 HUDSON DR STE 300
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4454
Practice Address - Country:US
Practice Address - Phone:330-655-5437
Practice Address - Fax:330-655-5435
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30215151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2482764Medicaid