Provider Demographics
NPI:1649566878
Name:GREGORY, ANDRA DUNHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANDRA
Middle Name:DUNHAM
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANDRA
Other - Middle Name:ELISE
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3701 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:TX
Mailing Address - Zip Code:79549-4630
Mailing Address - Country:US
Mailing Address - Phone:325-573-3162
Mailing Address - Fax:325-573-0942
Practice Address - Street 1:3701 AVENUE U
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:TX
Practice Address - Zip Code:79549-4630
Practice Address - Country:US
Practice Address - Phone:325-573-3162
Practice Address - Fax:325-573-0942
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice