Healthcare Provider Details

I. General information

NPI: 1790857670
Provider Name (Legal Business Name): GREGG E GEHRING D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 W MAIN ST
MADISON OH
44057-3126
US

IV. Provider business mailing address

48 WEST STREET
MADISON OH
44057
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-7118
  • Fax: 440-428-6139
Mailing address:
  • Phone: 440-428-7118
  • Fax: 440-428-6139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number15433
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: