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General NPI Number Information
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NPI Number | 1770305815
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Entity Type | Organization
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Legal Business Name | GREGORY DENTAL GROUP
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Dates
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Enumeration Date | 10/29/2024
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Last Update Date | 10/29/2024
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Provider Practice Location Address
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Address Line | 1746 W MAIN ST
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City | LEBANON
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State | TN
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Zip | 37087-3194
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Country | US
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Telephone | 615-444-0322
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Fax |
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Provider Business Mailing Address
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Address Line | 1746 W MAIN ST
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City | LEBANON
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State | TN
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Zip | 37087-3194
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Country | US
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Telephone | 615-444-0322
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DERRICK GREGORY
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Credential |
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Telephone | 615-444-0322
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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 |
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License Number State |
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