Provider Demographics
NPI:1689729485
Name:GREGERSON, NED O (DDS,MAGD,FICD)
Entity Type:Individual
Prefix:DR
First Name:NED
Middle Name:O
Last Name:GREGERSON
Suffix:
Gender:M
Credentials:DDS,MAGD,FICD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 S RIVER RD STE C215
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2102
Mailing Address - Country:US
Mailing Address - Phone:435-986-9799
Mailing Address - Fax:435-986-0699
Practice Address - Street 1:720 S RIVER RD STE C215
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2102
Practice Address - Country:US
Practice Address - Phone:435-986-9799
Practice Address - Fax:435-986-0699
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT133502122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist