Provider Demographics
NPI:1447391750
Name:PAINTER, GREGG LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:LEE
Last Name:PAINTER
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 1:202 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036
Mailing Address - Country:US
Mailing Address - Phone:815-777-2338
Mailing Address - Fax:815-777-9330
Practice Address - Street 1:202 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036
Practice Address - Country:US
Practice Address - Phone:815-777-2338
Practice Address - Fax:815-777-9330
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A14377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist