Provider Demographics
NPI:1649293861
Name:LUERDING, GREGORY A (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:LUERDING
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 1:1400 LAKE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-3014
Mailing Address - Country:US
Mailing Address - Phone:636-561-9000
Mailing Address - Fax:
Practice Address - Street 1:104 BREVCO PLZ
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1399
Practice Address - Country:US
Practice Address - Phone:636-561-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice