Provider Demographics
NPI:1417997776
Name:PARR, GREGORY R (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:R
Last Name:PARR
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 1:602 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8739
Mailing Address - Country:US
Mailing Address - Phone:706-226-1304
Mailing Address - Fax:706-278-7279
Practice Address - Street 1:602 MAIN ST
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8739
Practice Address - Country:US
Practice Address - Phone:706-226-1304
Practice Address - Fax:706-278-7279
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102341223P0700X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZG0234Medicaid
GA00167252AMedicaid