Provider Demographics
NPI:1588767461
Name:HUELER, GREGORY WARREN (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:WARREN
Last Name:HUELER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13875 HWY 13 FRONTAGE RD
Mailing Address - Street 2:SUITE 50
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378
Mailing Address - Country:US
Mailing Address - Phone:952-226-7940
Mailing Address - Fax:952-226-7949
Practice Address - Street 1:13875 HWY 13 FRONTAGE RD
Practice Address - Street 2:SUITE 50
Practice Address - City:SAVAGE
Practice Address - State:MN
Practice Address - Zip Code:55378
Practice Address - Country:US
Practice Address - Phone:952-226-7940
Practice Address - Fax:952-226-7949
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN098211223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
U32115Medicare UPIN