Provider Demographics
NPI:1053147363
Name:N. DEAN GREGSON, DMD, LLC
Entity type:Organization
Organization Name:N. DEAN GREGSON, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ALETA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-409-4614
Mailing Address - Street 1:17655 SE MCLOUGHLIN BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-5970
Mailing Address - Country:US
Mailing Address - Phone:503-659-1991
Mailing Address - Fax:
Practice Address - Street 1:17655 SE MCLOUGHLIN BLVD STE D
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97267-5970
Practice Address - Country:US
Practice Address - Phone:503-659-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty