Provider Demographics
NPI:1962589986
Name:GREGORY, DAVID ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEXANDER
Last Name:GREGORY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3011 RANCHO VISTA BLVD
Mailing Address - Street 2:#I
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551
Mailing Address - Country:US
Mailing Address - Phone:661-266-9785
Mailing Address - Fax:661-267-5874
Practice Address - Street 1:3011 RANCHO VISTA BLVD
Practice Address - Street 2:#I
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551
Practice Address - Country:US
Practice Address - Phone:661-266-9785
Practice Address - Fax:661-267-5874
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA312731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice