Provider Demographics
NPI:1457442352
Name:PFAU, GREGORY P (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:PFAU
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 1:10571 PROPOSAL POINTE WAY
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-8106
Mailing Address - Country:US
Mailing Address - Phone:317-513-9883
Mailing Address - Fax:
Practice Address - Street 1:3915 MADISON AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1364
Practice Address - Country:US
Practice Address - Phone:317-788-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007649122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist