Provider Demographics
NPI:1689801201
Name:STRAIT, GREGORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:STRAIT
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 1:165 E BAY AVE
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-3105
Mailing Address - Country:US
Mailing Address - Phone:609-978-8806
Mailing Address - Fax:
Practice Address - Street 1:165 E BAY AVE
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-3105
Practice Address - Country:US
Practice Address - Phone:609-978-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2013-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO2440500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist