Provider Demographics
NPI:1679637862
Name:ADAIR, GREGORY BERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:BERT
Last Name:ADAIR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4370
Mailing Address - Street 2:
Mailing Address - City:GYPSUM
Mailing Address - State:CO
Mailing Address - Zip Code:81637-4370
Mailing Address - Country:US
Mailing Address - Phone:970-328-6848
Mailing Address - Fax:970-328-1185
Practice Address - Street 1:35 LINDBERGH DR. STE.107
Practice Address - Street 2:
Practice Address - City:GYPSUM
Practice Address - State:CO
Practice Address - Zip Code:81637-4370
Practice Address - Country:US
Practice Address - Phone:970-328-6848
Practice Address - Fax:970-328-1185
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8496122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist