Provider Demographics
NPI:1295952356
Name:PUCEL, GREGORY A (D D S)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:PUCEL
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BAXTER RD
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-7032
Mailing Address - Country:US
Mailing Address - Phone:636-391-1911
Mailing Address - Fax:636-391-0629
Practice Address - Street 1:510 BAXTER RD
Practice Address - Street 2:SUITE # 3
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-7032
Practice Address - Country:US
Practice Address - Phone:636-391-1911
Practice Address - Fax:636-391-0629
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO137721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice