Provider Demographics
NPI:1689737926
Name:DICKINSON, GREGG ROY (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:ROY
Last Name:DICKINSON
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 1:2726 WOODLANE DR
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545
Mailing Address - Country:US
Mailing Address - Phone:608-756-3149
Mailing Address - Fax:608-756-0479
Practice Address - Street 1:2726 WOODLANE DR
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545
Practice Address - Country:US
Practice Address - Phone:608-756-3149
Practice Address - Fax:608-756-0479
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15806122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist