Provider Demographics
NPI:1437020807
Name:GREGORY, KOLBY GAGE
Entity type:Individual
Prefix:
First Name:KOLBY
Middle Name:GAGE
Last Name:GREGORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2899 US 31W
Mailing Address - Street 2:
Mailing Address - City:WHITE HOUSE
Mailing Address - State:TN
Mailing Address - Zip Code:37188
Mailing Address - Country:US
Mailing Address - Phone:615-672-3774
Mailing Address - Fax:615-672-9630
Practice Address - Street 1:2899 US 31W
Practice Address - Street 2:
Practice Address - City:WHITE HOUSE
Practice Address - State:TN
Practice Address - Zip Code:37188
Practice Address - Country:US
Practice Address - Phone:615-672-3774
Practice Address - Fax:615-672-9630
Is Sole Proprietor?:No
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12818122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist