Healthcare Provider Details

I. General information

NPI: 1013106780
Provider Name (Legal Business Name): GREGORY ALBERT GORGA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N CAMPBELL RD SUITE 2
ROYAL OAK MI
48067-1570
US

IV. Provider business mailing address

1010 N. CAMPBELL RD. SUITE 2
ROYAL OAK MI
48067
US

V. Phone/Fax

Practice location:
  • Phone: 248-541-3636
  • Fax: 248-547-7066
Mailing address:
  • Phone: 248-541-3636
  • Fax: 248-547-7066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10284
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: