Provider Demographics
NPI:1679817787
Name:TAIRA, GREGG S (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:S
Last Name:TAIRA
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 1:2 PROFESSIONAL DR STE 245
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3423
Mailing Address - Country:US
Mailing Address - Phone:301-963-9690
Mailing Address - Fax:301-963-1631
Practice Address - Street 1:2 PROFESSIONAL DR STE 245
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3423
Practice Address - Country:US
Practice Address - Phone:301-963-9690
Practice Address - Fax:301-963-1631
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699977231OtherNPI ORGANIZATION