Healthcare Provider Details

I. General information

NPI: 1477023778
Provider Name (Legal Business Name): GREGORY MCGEE, DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 07/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 WASHINGTON PKWY
IDAHO FALLS ID
83404-7596
US

IV. Provider business mailing address

2184 CHANNING WAY STE 229
IDAHO FALLS ID
83404-8034
US

V. Phone/Fax

Practice location:
  • Phone: 208-528-6000
  • Fax:
Mailing address:
  • Phone: 505-205-6618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: GREGORY MCGEE
Title or Position: PRESIDENT
Credential: DMD
Phone: 208-521-1891