Provider Demographics
NPI:1558548628
Name:DAVID D. GREAR, DDS, PC
Entity Type:Organization
Organization Name:DAVID D. GREAR, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREAR
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:231-796-2053
Mailing Address - Street 1:520 S 3RD AVE
Mailing Address - Street 2:PO BOX 514
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-9501
Mailing Address - Country:US
Mailing Address - Phone:231-796-2053
Mailing Address - Fax:
Practice Address - Street 1:520 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-9501
Practice Address - Country:US
Practice Address - Phone:231-796-2053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1571677Medicaid
MI2712090Medicaid