Provider Demographics
NPI:1760550933
Name:ALDRICH, GREGORY CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHARLES
Last Name:ALDRICH
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 1:4905 MANATEE AVENUE WEST
Mailing Address - Street 2:
Mailing Address - City:BRANDENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209
Mailing Address - Country:US
Mailing Address - Phone:941-792-8232
Mailing Address - Fax:941-761-2514
Practice Address - Street 1:4905 MANATEE AVENUE WEST
Practice Address - Street 2:
Practice Address - City:BRANDENTON
Practice Address - State:FL
Practice Address - Zip Code:34209
Practice Address - Country:US
Practice Address - Phone:941-792-8232
Practice Address - Fax:941-761-2514
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0011208122300000X
PADS025711L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist