1699144238 NPI number — GREGSON FAMILY DENTISTRY

Table of content: (NPI 1699144238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699144238 NPI number — GREGSON FAMILY DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGSON FAMILY DENTISTRY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
N.DEAN GREGSON
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699144238
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17655 SE MCLOUGHLIN BLVD.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKIE
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-659-1991
Provider Business Mailing Address Fax Number:
503-659-0117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17655 SE MCLOUGHLIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKIE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97267-5970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-659-1991
Provider Business Practice Location Address Fax Number:
503-659-0114
Provider Enumeration Date:
09/24/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GREGSON
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
DEAN
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
503-659-1991

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  D7090 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)