Provider Demographics
NPI:1447371588
Name:POOLE, GREGORY VANCE (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:VANCE
Last Name:POOLE
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 1:415 S COCHRAN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-2247
Mailing Address - Country:US
Mailing Address - Phone:517-543-4760
Mailing Address - Fax:
Practice Address - Street 1:415 S COCHRAN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-2247
Practice Address - Country:US
Practice Address - Phone:517-543-4760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI11111122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist