Provider Demographics
NPI:1881607091
Name:UECKERT, GREGG E (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:E
Last Name:UECKERT
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 1:7030 VILLAGE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3024
Mailing Address - Country:US
Mailing Address - Phone:512-345-3166
Mailing Address - Fax:512-345-0162
Practice Address - Street 1:7030 VILLAGE CENTER DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3024
Practice Address - Country:US
Practice Address - Phone:512-345-3166
Practice Address - Fax:512-345-0162
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX17663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies