Provider Demographics
NPI:1699934224
Name:GREGORY J. PEASE, DDS, P.C.
Entity type:Organization
Organization Name:GREGORY J. PEASE, DDS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PEASE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-867-2828
Mailing Address - Street 1:310 W 161ST ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-8566
Mailing Address - Country:US
Mailing Address - Phone:317-867-2828
Mailing Address - Fax:317-867-4020
Practice Address - Street 1:310 W 161ST ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-8566
Practice Address - Country:US
Practice Address - Phone:317-867-2828
Practice Address - Fax:317-867-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010370261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherEIN