Provider Demographics
NPI:1881901726
Name:GREEN GREGSON FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:GREEN GREGSON FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREGSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-849-0190
Mailing Address - Street 1:3812 RIDGELAKE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002
Mailing Address - Country:US
Mailing Address - Phone:504-849-0190
Mailing Address - Fax:504-849-0192
Practice Address - Street 1:3812 RIDGELAKE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002
Practice Address - Country:US
Practice Address - Phone:504-849-0190
Practice Address - Fax:504-849-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3148261QD0000X
122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty