Provider Demographics
NPI:1053520247
Name:SURRATT, GREGORY PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:PAUL
Last Name:SURRATT
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 1:100 COVEY DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-5665
Mailing Address - Country:US
Mailing Address - Phone:615-794-8998
Mailing Address - Fax:615-794-3511
Practice Address - Street 1:100 COVEY DR
Practice Address - Street 2:SUITE 311
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-5665
Practice Address - Country:US
Practice Address - Phone:615-794-8998
Practice Address - Fax:615-794-3511
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice