Provider Demographics
NPI:1336257252
Name:GREGORY, MARY E (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:GREGORY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:G
Other - Last Name:BALDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4500 OLD DOMINION DRIVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207
Mailing Address - Country:US
Mailing Address - Phone:703-527-6495
Mailing Address - Fax:703-527-6059
Practice Address - Street 1:4500 OLD DOMINION DRIVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207
Practice Address - Country:US
Practice Address - Phone:703-527-6495
Practice Address - Fax:703-527-6059
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA66751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice