John S.T. Gregg, DMD

Individual provider Active NPI General Practice Dentistry · Olyphant, PA

NPI 1922086024 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1922086024
Entity type
Individual (NPI type 1)
Primary specialty
General Practice Dentistry 1223G0001X
License
DS027367L (PA)
Practice address
500 Park St
Olyphant, PA 18447-1982
Phone
(570) 383-9066
Fax
(570) 383-4183
NPI assigned
Jan 9, 2006
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
DS027367LPAMDGeneral Practice Dentistry

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DS027367L PA Yes

Addresses

Primary practice location

500 Park St
Olyphant, PA 18447-1982

Mailing address

500 Park St
Olyphant, PA 18447-1982
Phone (570) 383-9066

Other providers in Olyphant, PA

All providers in Olyphant, PA · General Practice Dentistry in Pennsylvania

Sources for this page

Verify at the official NPI Registry.