Provider Demographics
NPI:1851431126
Name:SMITH, GREGORY J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:J
Last Name:SMITH
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 1:18361 BEAR VALLEY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345
Mailing Address - Country:US
Mailing Address - Phone:760-949-1507
Mailing Address - Fax:760-949-0491
Practice Address - Street 1:18361 BEAR VALLEY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345
Practice Address - Country:US
Practice Address - Phone:760-949-1507
Practice Address - Fax:760-949-0491
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist