Provider Demographics
NPI:1740385640
Name:ELLER, GREGORY D (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:ELLER
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 1:101 WESTVIEW PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-1107
Mailing Address - Fax:406-752-1124
Practice Address - Street 1:101 WESTVIEW PARK PLACE
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-1107
Practice Address - Fax:406-752-1124
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2272122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist