Healthcare Provider Details

I. General information

NPI: 1922731223
Provider Name (Legal Business Name): GREGG ALLEN PUTNAM JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 MAGAZINE ST
NEW ORLEANS LA
70115-1735
US

IV. Provider business mailing address

4914 MAGAZINE ST
NEW ORLEANS LA
70115-1735
US

V. Phone/Fax

Practice location:
  • Phone: 504-899-1556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number7361
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: