Healthcare Provider Details

I. General information

NPI: 1760550933
Provider Name (Legal Business Name): GREGORY CHARLES ALDRICH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 08/28/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 MANATEE AVENUE WEST
BRANDENTON FL
34205
US

IV. Provider business mailing address

4322 HIDDEN RIVER ROAD
SARASOTA FL
34240-8637
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-8232
  • Fax: 941-243-3142
Mailing address:
  • Phone: 941-792-8232
  • Fax: 941-243-3142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS025711L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN0011208
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: