Provider Demographics
NPI:1457472342
Name:M.G. DDS PC
Entity Type:Organization
Organization Name:M.G. DDS PC
Other - Org Name:GREDER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTI
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GREDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-558-6220
Mailing Address - Street 1:9202 W DODGE RD #201
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3246
Mailing Address - Country:US
Mailing Address - Phone:402-558-6220
Mailing Address - Fax:402-558-3849
Practice Address - Street 1:9202 W DODGE RD #201
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3246
Practice Address - Country:US
Practice Address - Phone:402-558-6220
Practice Address - Fax:402-558-3849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty