Provider Demographics
NPI:1699753467
Name:DEJEAN, GREGORY O (DDS (PEDIATRIC DENT))
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:O
Last Name:DEJEAN
Suffix:
Gender:M
Credentials:DDS (PEDIATRIC DENT)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 E 90TH ST
Mailing Address - Street 2:# 3A
Mailing Address - City:NYC
Mailing Address - State:NY
Mailing Address - Zip Code:10128-2342
Mailing Address - Country:US
Mailing Address - Phone:212-996-2550
Mailing Address - Fax:
Practice Address - Street 1:345 E 24TH ST
Practice Address - Street 2:ATTN: PEDIATRIC DENTISTRY DEPT.
Practice Address - City:NYC
Practice Address - State:NY
Practice Address - Zip Code:10010-4020
Practice Address - Country:US
Practice Address - Phone:212-998-9657
Practice Address - Fax:212-995-4242
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045705-11223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry