Provider Demographics
NPI:1700902061
Name:GREMZA, DAVID P
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:P
Last Name:GREMZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 SANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-2608
Mailing Address - Country:US
Mailing Address - Phone:401-949-1099
Mailing Address - Fax:401-949-0699
Practice Address - Street 1:29 SANDERSON RD
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-2608
Practice Address - Country:US
Practice Address - Phone:401-949-1099
Practice Address - Fax:401-949-0699
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN02768122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist