Healthcare Provider Details

I. General information

NPI: 1518459437
Provider Name (Legal Business Name): ALLISON E. GREGORY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 06/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13820 OLD SAINT AUGUSTINE RD STE 105
JACKSONVILLE FL
32258-5424
US

IV. Provider business mailing address

13820 OLD SAINT AUGUSTINE RD STE 105
JACKSONVILLE FL
32258-5424
US

V. Phone/Fax

Practice location:
  • Phone: 904-260-7700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN23406
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: