Healthcare Provider Details

I. General information

NPI: 1053147363
Provider Name (Legal Business Name): N. DEAN GREGSON, DMD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2024
Last Update Date: 09/12/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17655 SE MCLOUGHLIN BLVD STE D
MILWAUKIE OR
97267-5970
US

IV. Provider business mailing address

17655 SE MCLOUGHLIN BLVD STE D
MILWAUKIE OR
97267-5970
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-1991
  • Fax:
Mailing address:
  • Phone: 503-659-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: ALETA BEUTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 775-409-4614