Provider Demographics
NPI:1649341215
Name:NIP, GREGORY CHARLES (DDS)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:CHARLES
Last Name:NIP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3749 NORIEGA STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-3903
Mailing Address - Country:US
Mailing Address - Phone:415-661-8851
Mailing Address - Fax:415-661-8853
Practice Address - Street 1:3749 NORIEGA STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-3903
Practice Address - Country:US
Practice Address - Phone:415-661-8851
Practice Address - Fax:415-661-8853
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA403821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice