Provider Demographics
NPI:1922086024
Name:GREGG, JOHN ST (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ST
Last Name:GREGG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PARK ST
Mailing Address - Street 2:
Mailing Address - City:OLYPHANT
Mailing Address - State:PA
Mailing Address - Zip Code:18447-1982
Mailing Address - Country:US
Mailing Address - Phone:570-383-9066
Mailing Address - Fax:570-383-4183
Practice Address - Street 1:500 PARK ST
Practice Address - Street 2:
Practice Address - City:OLYPHANT
Practice Address - State:PA
Practice Address - Zip Code:18447-1982
Practice Address - Country:US
Practice Address - Phone:570-383-9066
Practice Address - Fax:570-383-4183
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027367L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice