Provider Demographics
NPI:1144354655
Name:PRITCHETT, GREGORY S (DDS)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:PRITCHETT
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 1:860 OAK PARK BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-1800
Mailing Address - Country:US
Mailing Address - Phone:805-489-5559
Mailing Address - Fax:805-489-9497
Practice Address - Street 1:860 OAK PARK BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-1800
Practice Address - Country:US
Practice Address - Phone:805-489-5559
Practice Address - Fax:805-489-9497
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD47309Medicaid