Provider Demographics
NPI:1053310987
Name:GREGORY S GORMAN DDS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GREGORY S GORMAN DDS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:831-424-2986
Mailing Address - Street 1:780 E ROMIE LN
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-4223
Mailing Address - Country:US
Mailing Address - Phone:831-424-2986
Mailing Address - Fax:831-424-7132
Practice Address - Street 1:780 E ROMIE LN
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-4223
Practice Address - Country:US
Practice Address - Phone:831-424-2986
Practice Address - Fax:831-424-7132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 25893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty