Healthcare Provider Details

I. General information

NPI: 1124144423
Provider Name (Legal Business Name): GREGORY JOSEPH PAPROCKI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 09/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 JEFFERSON AVE DENTAL SERVICE (160)
MEMPHIS TN
38104
US

IV. Provider business mailing address

1030 JEFFERSON AVE DENTAL SERVICE (160)
MEMPHIS TN
38104
US

V. Phone/Fax

Practice location:
  • Phone: 901-523-8990
  • Fax: 901-302-3543
Mailing address:
  • Phone: 901-523-8990
  • Fax: 901-302-3543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9269
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: