Provider Demographics
NPI:1336960541
Name:GREGORY DENTAL, LLC
Entity type:Organization
Organization Name:GREGORY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INS DEPT. MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEDDLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-769-6119
Mailing Address - Street 1:112 E GREGORY BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1120
Mailing Address - Country:US
Mailing Address - Phone:816-363-1020
Mailing Address - Fax:
Practice Address - Street 1:112 E GREGORY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1120
Practice Address - Country:US
Practice Address - Phone:816-363-1020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty