Provider Demographics
NPI:1811076334
Name:NOTESTINE, GREGORY E (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
Last Name:NOTESTINE
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 1:2149 N FAIRFIELD RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-2559
Mailing Address - Country:US
Mailing Address - Phone:937-431-9916
Mailing Address - Fax:937-431-9923
Practice Address - Street 1:2149 N FAIRFIELD RD
Practice Address - Street 2:SUITE D
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-2559
Practice Address - Country:US
Practice Address - Phone:937-431-9916
Practice Address - Fax:937-431-9923
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice