Provider Demographics
NPI:1417971383
Name:RASHALL, GREGORY WARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WARD
Last Name:RASHALL
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:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:TX
Mailing Address - Zip Code:77575-1599
Mailing Address - Country:US
Mailing Address - Phone:936-336-5171
Mailing Address - Fax:936-336-8219
Practice Address - Street 1:315 CROCKETT ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-4716
Practice Address - Country:US
Practice Address - Phone:936-336-5171
Practice Address - Fax:936-336-8219
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice