Provider Demographics
NPI:1891756367
Name:MCGEE, GREGORY R (DMD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:R
Last Name:MCGEE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7596
Mailing Address - Country:US
Mailing Address - Phone:208-528-6000
Mailing Address - Fax:208-528-6399
Practice Address - Street 1:3905 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7596
Practice Address - Country:US
Practice Address - Phone:208-528-6000
Practice Address - Fax:208-528-6399
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WY15451223S0112X
NM26981223S0112X
IDD-4979-OS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery