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General NPI Number Information
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NPI Number | 1275634396
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Entity Type | Individual
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Provider Name | GREG MCPHERSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 02/18/2010
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Provider Practice Location Address
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Address Line | 3241 RUE ROYALE
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City | SAINT CHARLES
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State | MO
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Zip | 63301-8225
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Country | US
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Telephone | 636-493-1960
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Fax | 636-493-1963
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Provider Business Mailing Address
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Address Line | 3241 RUE ROYALE
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City | SAINT CHARLES
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State | MO
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Zip | 63301-8225
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Country | US
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Telephone | 636-493-1960
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Fax | 636-493-1963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2067
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2009007429
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.028099
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License Number State | IL
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