Provider Demographics
NPI:1982685749
Name:BLYTHE, GREGORY ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALAN
Last Name:BLYTHE
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:US ARMY DENTAL ACTIVITY HAWAII
Mailing Address - Street 2:1 JARRETT WHITE ROAD, ATTN MCDS-NH
Mailing Address - City:TRIPLER AMC
Mailing Address - State:HI
Mailing Address - Zip Code:96859-5000
Mailing Address - Country:US
Mailing Address - Phone:808-433-1021
Mailing Address - Fax:808-433-3928
Practice Address - Street 1:US ARMY DENTAL ACTIVITY HAWAII
Practice Address - Street 2:1 JARRETT WHITE ROAD, ATTN MCDS-NH
Practice Address - City:TRIPLER AMC
Practice Address - State:HI
Practice Address - Zip Code:96859-5000
Practice Address - Country:US
Practice Address - Phone:808-433-1021
Practice Address - Fax:808-433-3928
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2013-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300176291223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics