Provider Demographics
NPI:1336759208
Name:DAVID B. GREGORY, D.D.S.,P.A.
Entity type:Organization
Organization Name:DAVID B. GREGORY, D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:WIDEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-792-4889
Mailing Address - Street 1:3302 64TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79413-5743
Mailing Address - Country:US
Mailing Address - Phone:806-792-4889
Mailing Address - Fax:806-793-2624
Practice Address - Street 1:3302 64TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79413-5743
Practice Address - Country:US
Practice Address - Phone:806-792-4889
Practice Address - Fax:806-793-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental