Provider Demographics
NPI:1578743456
Name:GREGGORY P. GECHOFF, DDS, MS, APC
Entity Type:Organization
Organization Name:GREGGORY P. GECHOFF, DDS, MS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:GECHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS, APC
Authorized Official - Phone:619-448-1611
Mailing Address - Street 1:8770 CUYAMACA ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-4373
Mailing Address - Country:US
Mailing Address - Phone:619-448-1611
Mailing Address - Fax:619-448-4630
Practice Address - Street 1:8770 CUYAMACA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-4373
Practice Address - Country:US
Practice Address - Phone:619-448-1611
Practice Address - Fax:619-448-4630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-08
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA444791223X0400X
CA209811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB-20981-01OtherMEDI-CAL