Provider Demographics
NPI:1831176056
Name:DIMMICH, GREGORY W (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:W
Last Name:DIMMICH
Suffix:
Gender:M
Credentials:DMD
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Mailing Address - Street 1:1251 S CEDAR CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6205
Mailing Address - Country:US
Mailing Address - Phone:610-435-6161
Mailing Address - Fax:610-435-2902
Practice Address - Street 1:1251 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6205
Practice Address - Country:US
Practice Address - Phone:610-435-6161
Practice Address - Fax:610-435-2902
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2015-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS-025059204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01349601OtherCBC #
PA126987OtherHBS #
PA126987OtherHBS #