Provider Demographics
NPI:1083900021
Name:CALLOWAY, GREGORY ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:CALLOWAY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 SW WHITE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-2426
Mailing Address - Country:US
Mailing Address - Phone:816-350-9119
Mailing Address - Fax:
Practice Address - Street 1:4045 NE LAKEWOOD WAY STE 150
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-1997
Practice Address - Country:US
Practice Address - Phone:816-350-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20110144331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice