Provider Demographics
NPI:1710198171
Name:REKOS, GREG ALAN (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALAN
Last Name:REKOS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9292 WAYNEBROWN DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7786
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5155 BRADENTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-7558
Practice Address - Country:US
Practice Address - Phone:614-764-9455
Practice Address - Fax:614-526-3745
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0231911223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery