Provider Demographics
NPI:1851508600
Name:GORMAN, GREGORY STEPHEN (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:STEPHEN
Last Name:GORMAN
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 1:780 E ROMIE LN
Mailing Address - Street 2:#B
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4223
Mailing Address - Country:US
Mailing Address - Phone:831-424-2986
Mailing Address - Fax:831-424-7132
Practice Address - Street 1:780 E ROMIE LN
Practice Address - Street 2:#B
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4223
Practice Address - Country:US
Practice Address - Phone:831-424-2986
Practice Address - Fax:831-424-7132
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA258931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice