Provider Demographics
NPI:1871702688
Name:R C GREGORIN II DDS LLC
Entity type:Organization
Organization Name:R C GREGORIN II DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:GREGORIN
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-333-2061
Mailing Address - Street 1:6105 EASTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4430
Mailing Address - Country:US
Mailing Address - Phone:907-333-2061
Mailing Address - Fax:907-868-3136
Practice Address - Street 1:6901 E TUDOR RD
Practice Address - Street 2:SUITE #9
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1241
Practice Address - Country:US
Practice Address - Phone:907-333-5522
Practice Address - Fax:907-333-5707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1034261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental