1578743456 NPI number — GREGGORY P. GECHOFF, DDS, MS, APC

Table of content: (NPI 1578743456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578743456 NPI number — GREGGORY P. GECHOFF, DDS, MS, APC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGGORY P. GECHOFF, DDS, MS, APC
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:
Provider Other Organization Name Type Code:
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:
1578743456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8770 CUYAMACA ST
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
SANTEE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92071-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-448-1611
Provider Business Mailing Address Fax Number:
619-448-4630

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8770 CUYAMACA ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
SANTEE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92071-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-448-1611
Provider Business Practice Location Address Fax Number:
619-448-4630
Provider Enumeration Date:
11/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GECHOFF
Authorized Official First Name:
GREGGORY
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
619-448-1611

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X , with the licence number:  44479 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223X0400X , with the licence number: 20981 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: B-20981-01 . This is a "MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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