Provider Demographics
NPI:1649353269
Name:MOEGLING, GREGORY JOHN (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHN
Last Name:MOEGLING
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 1:13203 HADLEY ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-4519
Mailing Address - Country:US
Mailing Address - Phone:562-698-9903
Mailing Address - Fax:562-698-7982
Practice Address - Street 1:13203 HADLEY ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-4519
Practice Address - Country:US
Practice Address - Phone:562-698-9903
Practice Address - Fax:562-698-7982
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice