Healthcare Provider Details

I. General information

NPI: 1144286329
Provider Name (Legal Business Name): GREGORY TROMPETER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 W HIGH ST
JACKSON MI
49203-2986
US

IV. Provider business mailing address

PO BOX 548
JACKSON MI
49204-0548
US

V. Phone/Fax

Practice location:
  • Phone: 517-784-9385
  • Fax: 517-787-0852
Mailing address:
  • Phone: 517-784-3950
  • Fax: 517-783-2728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2901018755
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: