Provider Demographics
NPI:1407905003
Name:APPLEGATE, GREGORY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:APPLEGATE
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 1:3590 N BRIARWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47304-5211
Mailing Address - Country:US
Mailing Address - Phone:765-747-9611
Mailing Address - Fax:765-747-9990
Practice Address - Street 1:3590 N BRIARWOOD LN
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-5211
Practice Address - Country:US
Practice Address - Phone:765-747-9611
Practice Address - Fax:765-747-9990
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120096161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice