Provider Demographics
NPI:1972823029
Name:ROMNEY, GREGORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:ROMNEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:ROMNEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:6755 E SUPERSTITION SPRINGS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4375
Mailing Address - Country:US
Mailing Address - Phone:480-830-5866
Mailing Address - Fax:480-807-0606
Practice Address - Street 1:6755 E SUPERSTITION SPRINGS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4375
Practice Address - Country:US
Practice Address - Phone:480-830-5866
Practice Address - Fax:480-807-0606
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0080591223S0112X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program