Provider Demographics
NPI:1851408355
Name:GRES, JOHN ELIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ELIE
Last Name:GRES
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 1:623 E. HEMPSTEAD ST.
Mailing Address - Street 2:
Mailing Address - City:GIDDINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78942-3419
Mailing Address - Country:US
Mailing Address - Phone:979-542-1298
Mailing Address - Fax:
Practice Address - Street 1:623 E HEMPSTEAD ST
Practice Address - Street 2:
Practice Address - City:GIDDINGS
Practice Address - State:TX
Practice Address - Zip Code:78942-3419
Practice Address - Country:US
Practice Address - Phone:979-542-1298
Practice Address - Fax:979-542-0440
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice