=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124144423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGORY JOSEPH PAPROCKI D.D.S.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2007
-----------------------------------------------------
Last Update Date | 09/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1030 JEFFERSON AVE DENTAL SERVICE (160)
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-523-8990
-----------------------------------------------------
Fax | 901-302-3543
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1030 JEFFERSON AVE DENTAL SERVICE (160)
-----------------------------------------------------
City | MEMPHIS
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38104
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-523-8990
-----------------------------------------------------
Fax | 901-302-3543
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0700X
-----------------------------------------------------
Taxonomy Name | Prosthodontics
-----------------------------------------------------
License Number | 9269
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------