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General NPI Number Information
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NPI Number | 1336759208
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Entity Type | Organization
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Legal Business Name | DAVID B. GREGORY, D.D.S.,P.A.
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Dates
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Enumeration Date | 08/05/2020
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 3302 64TH ST
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City | LUBBOCK
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State | TX
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Zip | 79413-5743
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Country | US
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Telephone | 806-792-4889
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Fax | 806-793-2624
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Provider Business Mailing Address
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Address Line | 3302 64TH ST
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City | LUBBOCK
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State | TX
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Zip | 79413-5743
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Country | US
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Telephone | 806-792-4889
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Fax | 806-793-2624
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | KIM WIDEMAN
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Credential |
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Telephone | 806-792-4889
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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