Provider Demographics
NPI:1467436840
Name:BABER, GREGORY LEE (DMD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:BABER
Suffix:
Gender:M
Credentials:DMD
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 1789
Mailing Address - Street 2:
Mailing Address - City:UVALDE
Mailing Address - State:TX
Mailing Address - Zip Code:78802-1789
Mailing Address - Country:US
Mailing Address - Phone:830-278-3888
Mailing Address - Fax:830-278-3838
Practice Address - Street 1:2100 GARNER FIELD RD
Practice Address - Street 2:SUITE A
Practice Address - City:UVALDE
Practice Address - State:TX
Practice Address - Zip Code:78801-6216
Practice Address - Country:US
Practice Address - Phone:830-278-3888
Practice Address - Fax:830-278-3838
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9170402Medicaid
TXU25615Medicare UPIN
TN8A6990Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE