Provider Demographics
NPI:1851312748
Name:GRESSET, GREGORY LEON (DDS, PS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:LEON
Last Name:GRESSET
Suffix:
Gender:M
Credentials:DDS, PS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:15515 3RD AVE SW
Mailing Address - Street 2:#E
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2553
Mailing Address - Country:US
Mailing Address - Phone:206-248-3035
Mailing Address - Fax:206-248-1463
Practice Address - Street 1:15515 3RD AVE SW
Practice Address - Street 2:#E
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2553
Practice Address - Country:US
Practice Address - Phone:206-248-3035
Practice Address - Fax:206-248-1463
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA49311223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01617Medicare UPIN