Provider Demographics
NPI:1649223884
Name:SY, GREGORY ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ROBERT
Last Name:SY
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 1:1755 COOPER FOSTER PARK RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:OH
Mailing Address - Zip Code:44001-1200
Mailing Address - Country:US
Mailing Address - Phone:440-282-9550
Mailing Address - Fax:440-282-8205
Practice Address - Street 1:1755 COOPER FOSTER PARK RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:OH
Practice Address - Zip Code:44001-1200
Practice Address - Country:US
Practice Address - Phone:440-282-9550
Practice Address - Fax:440-282-8205
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH190521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice