Provider Demographics
NPI:1972522530
Name:PYLE, GREGORY WYNN (DMD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:WYNN
Last Name:PYLE
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 1:138 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7028
Mailing Address - Country:US
Mailing Address - Phone:814-623-1022
Mailing Address - Fax:
Practice Address - Street 1:138 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7028
Practice Address - Country:US
Practice Address - Phone:814-623-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026308L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA27103OtherGEISINGER HEALTH PLAN
PA200074OtherUPMC HEALTH PLAN
PA27103OtherGEISINGER HEALTH PLAN
PA005356TW6Medicare ID - Type Unspecified