Healthcare Provider Details

I. General information

NPI: 1528037413
Provider Name (Legal Business Name): GREGORY MARK NESS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 04/01/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1161 BETHEL RD STE 303
COLUMBUS OH
43220-2773
US

IV. Provider business mailing address

1151 BETHEL RD STE 104
COLUMBUS OH
43220-2775
US

V. Phone/Fax

Practice location:
  • Phone: 614-457-9337
  • Fax: 614-456-7551
Mailing address:
  • Phone: 614-457-9337
  • Fax: 614-705-1867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8588
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30.019063
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number30.019063
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: