MEDICARE: DR. GREGORY M KAISER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12013625A	IN

General Provider Information

NPI Number	:	1073189049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY M KAISER DDS

Provider Business Mailing Address
First Line	:	1483 STARCROSS LN APT 105
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46280-2987
Country	:	US
Telephone Number	:	260-417-0350
Fax Number	:

Provider Business Practice Location Address
First Line	:	4341 FLAGSTAFF CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4400
Country	:	US
Telephone Number	:	260-493-2432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2021
Last Update Date	:	06/01/2021

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