Provider Demographics
NPI:1912142100
Name:FURDEK, GREGORY S (DDS)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:FURDEK
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 1:1060 GAFFNEY RD #7500 USA DENTAC ALASKA
Mailing Address - Street 2:FT. WAINWRIGHT ATTN: CREDENTIALS COORDINATOR
Mailing Address - City:FORT WAINWRIGHT
Mailing Address - State:AK
Mailing Address - Zip Code:99703-7500
Mailing Address - Country:US
Mailing Address - Phone:907-361-5530
Mailing Address - Fax:907-361-5530
Practice Address - Street 1:1060 GAFFNEY RD #7500 USA DENTAC ALASKA
Practice Address - Street 2:FT. WAINWRIGHT ATTN: CREDENTIALS COORDINATOR
Practice Address - City:FORT WAINWRIGHT
Practice Address - State:AK
Practice Address - Zip Code:99703-7500
Practice Address - Country:US
Practice Address - Phone:907-361-5530
Practice Address - Fax:907-361-4859
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6322-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist