Provider Demographics
NPI:1891921110
Name:PETTE, GREGORY ASHER (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ASHER
Last Name:PETTE
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25195 CHAMBER OF COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7895
Mailing Address - Country:US
Mailing Address - Phone:239-947-7481
Mailing Address - Fax:
Practice Address - Street 1:25195 CHAMBER OF COMMERCE DR
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7895
Practice Address - Country:US
Practice Address - Phone:239-947-7481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN182911223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics