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General NPI Number Information
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NPI Number | 1467535666
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Entity Type | Individual
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Provider Name | GREGORY JOHN PEASE DDS
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Gender | Male
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Dates
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Enumeration Date | 10/23/2006
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 310 W 161ST ST
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City | WESTFIELD
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State | IN
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Zip | 46074-8566
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Country | US
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Telephone | 317-867-2828
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Fax | 317-867-4020
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Provider Business Mailing Address
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Address Line | 310 W 161ST ST
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City | WESTFIELD
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State | IN
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Zip | 46074-8566
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Country | US
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Telephone | 317-867-2828
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Fax | 317-867-4020
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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 | 12010370A
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License Number State | IN
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