Provider Demographics
NPI:1417401472
Name:GREGORY DORSETT, PLLC
Entity Type:Organization
Organization Name:GREGORY DORSETT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:DORSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-303-0916
Mailing Address - Street 1:102312 KASH LOOP
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338-0010
Mailing Address - Country:US
Mailing Address - Phone:509-303-0916
Mailing Address - Fax:
Practice Address - Street 1:312 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7702
Practice Address - Country:US
Practice Address - Phone:509-735-6341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60298149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty