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General NPI Number Information
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NPI Number | 1821262213
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Entity Type | Individual
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Provider Name | GREGORY KON DDS
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Gender | Male
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 3301 NORTHLAND DR SUITE 210
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City | AUSTIN
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State | TX
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Zip | 78731-4939
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Country | US
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Telephone | 512-458-6984
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Fax |
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Provider Business Mailing Address
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Address Line | 411 E HUNTINGTON DR #107-142
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City | ARCADIA
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State | CA
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Zip | 91006-3731
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Country | US
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Telephone | 512-458-6984
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 41935
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 25128
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License Number State | TX
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