Provider Demographics
NPI:1215079363
Name:BEMIS, GREGORY NORMAN (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:NORMAN
Last Name:BEMIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2415
Mailing Address - Country:US
Mailing Address - Phone:203-250-3446
Mailing Address - Fax:
Practice Address - Street 1:314 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2415
Practice Address - Country:US
Practice Address - Phone:203-250-3446
Practice Address - Fax:203-250-3446
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0525871223G0001X
CT106321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02801825Medicaid