Provider Demographics
NPI:1255603288
Name:GREGG L. PAINTER, DDS, PC
Entity type:Organization
Organization Name:GREGG L. PAINTER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGG
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-777-2338
Mailing Address - Street 1:202 SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:IL
Mailing Address - Zip Code:61036-1636
Mailing Address - Country:US
Mailing Address - Phone:815-777-2338
Mailing Address - Fax:815-777-2338
Practice Address - Street 1:202 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-1636
Practice Address - Country:US
Practice Address - Phone:815-777-2338
Practice Address - Fax:815-777-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060010749122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty