Provider Demographics
NPI:1417098351
Name:FERTIK, GREG S (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
Last Name:FERTIK
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BEVERLY HANKS CTR
Mailing Address - Street 2:SUITE B
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-2301
Mailing Address - Country:US
Mailing Address - Phone:828-693-7533
Mailing Address - Fax:
Practice Address - Street 1:200 BEVERLY HANKS CTR
Practice Address - Street 2:SUITE B
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-2301
Practice Address - Country:US
Practice Address - Phone:828-693-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60311223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics