Provider Demographics
NPI:1194998724
Name:GREGOIRE, SUZANNE ELIZABETH (PHD, DMD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:ELIZABETH
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:PHD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 FRANCIS PLACE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-2465
Mailing Address - Country:US
Mailing Address - Phone:314-721-1661
Mailing Address - Fax:
Practice Address - Street 1:950 FRANCIS PL
Practice Address - Street 2:SUITE 206
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-2465
Practice Address - Country:US
Practice Address - Phone:314-721-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO135541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice