Provider Demographics
NPI:1013118611
Name:HACK, GREGORY ADRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ADRIAN
Last Name:HACK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:6 STONEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLD LYME
Mailing Address - State:CT
Mailing Address - Zip Code:06371-1845
Mailing Address - Country:US
Mailing Address - Phone:860-434-1610
Mailing Address - Fax:860-434-9656
Practice Address - Street 1:196 PARKWAY S
Practice Address - Street 2:SUITE 305
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-1234
Practice Address - Country:US
Practice Address - Phone:860-443-1827
Practice Address - Fax:860-443-1745
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0077231223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics