Provider Demographics
NPI:1306061981
Name:GREGORY, RICHARD WILSON (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WILSON
Last Name:GREGORY
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 1:34501 AURORA RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SOLON
Mailing Address - State:OH
Mailing Address - Zip Code:44139-3873
Mailing Address - Country:US
Mailing Address - Phone:440-542-6400
Mailing Address - Fax:440-542-9244
Practice Address - Street 1:34501 AURORA RD
Practice Address - Street 2:SUITE 302
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-3873
Practice Address - Country:US
Practice Address - Phone:440-542-6400
Practice Address - Fax:440-542-9244
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 . 015914122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist