Provider Demographics
NPI:1386846087
Name:GREGORY D. PRIESTON DDS PC
Entity type:Organization
Organization Name:GREGORY D. PRIESTON DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:DEEMS
Authorized Official - Last Name:PRIESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-853-6626
Mailing Address - Street 1:5 EVERSLEY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5821
Mailing Address - Country:US
Mailing Address - Phone:203-853-6626
Mailing Address - Fax:203-853-7073
Practice Address - Street 1:5 EVERSLEY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5821
Practice Address - Country:US
Practice Address - Phone:203-853-6626
Practice Address - Fax:203-853-7073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005682261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental