Provider Demographics
NPI:1528037413
Name:NESS, GREGORY MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:MARK
Last Name:NESS
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 1:1151 BETHEL RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2775
Mailing Address - Country:US
Mailing Address - Phone:614-457-9337
Mailing Address - Fax:614-705-1867
Practice Address - Street 1:1161 BETHEL RD STE 303
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2773
Practice Address - Country:US
Practice Address - Phone:614-457-9337
Practice Address - Fax:614-456-7551
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA85881223S0112X
OH30.0190631223S0112X, 204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010217215Medicaid
OH0886215Medicaid
OHNE0720501Medicare ID - Type Unspecified
OHH041580Medicare PIN
OH0886215Medicaid
VA007918V30Medicare PIN
VAU35649Medicare UPIN