Provider Demographics
NPI:1326711771
Name:VESTA, GREGG II (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:VESTA
Suffix:II
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 1:32350 INTERSTATE 10 W
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-9214
Mailing Address - Country:US
Mailing Address - Phone:830-249-2045
Mailing Address - Fax:
Practice Address - Street 1:32350 INTERSTATE 10 W
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9214
Practice Address - Country:US
Practice Address - Phone:830-249-2045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-30
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice