Provider Demographics
NPI:1114238128
Name:GREGERSON, JEFFREY BOYD (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:BOYD
Last Name:GREGERSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3401 EL SALIDO PKWY
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2550
Mailing Address - Country:US
Mailing Address - Phone:512-401-8888
Mailing Address - Fax:512-401-8887
Practice Address - Street 1:14005 N HWY 183 STE 800
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5960
Practice Address - Country:US
Practice Address - Phone:512-644-1752
Practice Address - Fax:512-266-6197
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0382291223P0221X
TX252451223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry