Provider Demographics
NPI:1902817331
Name:KAMP, GREGORY G (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:G
Last Name:KAMP
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 1:11903 E WELLAND ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:CUMBERLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3979
Mailing Address - Country:US
Mailing Address - Phone:317-894-4298
Mailing Address - Fax:
Practice Address - Street 1:11903 E WELLAND ST
Practice Address - Street 2:SUITE A
Practice Address - City:CUMBERLAND
Practice Address - State:IN
Practice Address - Zip Code:46229-3979
Practice Address - Country:US
Practice Address - Phone:317-894-4298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN73541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice