Provider Demographics
NPI:1588873384
Name:GREGORIN, RICHARD CHARLES II (DDS)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHARLES
Last Name:GREGORIN
Suffix:II
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6105 EASTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4430
Mailing Address - Country:US
Mailing Address - Phone:907-333-2061
Mailing Address - Fax:907-868-3136
Practice Address - Street 1:6901 E TUDOR RD
Practice Address - Street 2:SUITE #9
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1241
Practice Address - Country:US
Practice Address - Phone:907-333-5522
Practice Address - Fax:907-333-5707
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist