Provider Demographics
NPI:1477630341
Name:TEMPLE, J. GREG (DDS)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:GREG
Last Name:TEMPLE
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 1:2508 S CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71601-6446
Mailing Address - Country:US
Mailing Address - Phone:870-534-7373
Mailing Address - Fax:870-534-7660
Practice Address - Street 1:2508 S CHERRY ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-6446
Practice Address - Country:US
Practice Address - Phone:870-534-7373
Practice Address - Fax:870-534-7660
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR23231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice