Healthcare Provider Details

I. General information

NPI: 1891756367
Provider Name (Legal Business Name): GREGORY R MCGEE D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 02/09/2021
Certification Date: 02/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3905 WASHINGTON PKWY
IDAHO FALLS ID
83404-7596
US

IV. Provider business mailing address

3905 WASHINGTON PKWY
IDAHO FALLS ID
83404-7596
US

V. Phone/Fax

Practice location:
  • Phone: 208-528-6000
  • Fax: 208-528-6399
Mailing address:
  • Phone: 208-528-6000
  • Fax: 208-528-6399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number1545
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number2698
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD-4979-OS
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: