Provider Demographics
NPI:1710145222
Name:GREGORICH, JOSEPH ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ADAM
Last Name:GREGORICH
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 1:1819 YOSEMITE AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811-1901
Mailing Address - Country:US
Mailing Address - Phone:218-349-5586
Mailing Address - Fax:
Practice Address - Street 1:601 HIGHWAY 73
Practice Address - Street 2:BOX 46
Practice Address - City:FLOODWOOD
Practice Address - State:MN
Practice Address - Zip Code:55736
Practice Address - Country:US
Practice Address - Phone:218-476-2969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12516122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist