Provider Demographics
NPI:1205980414
Name:GREGORSOK, ROBERT LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:GREGORSOK
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 1:1301 W 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-2113
Mailing Address - Country:US
Mailing Address - Phone:319-277-4600
Mailing Address - Fax:319-266-5270
Practice Address - Street 1:1301 W 1ST ST
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50613-2113
Practice Address - Country:US
Practice Address - Phone:319-277-4600
Practice Address - Fax:319-266-5270
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082891223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist