Provider Demographics
NPI:1497971915
Name:SVOMA, GREGG STEVEN
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:STEVEN
Last Name:SVOMA
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 1:7130 E CO RD 150 SOUTH
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8190
Mailing Address - Country:US
Mailing Address - Phone:317-837-8900
Mailing Address - Fax:317-837-8908
Practice Address - Street 1:7130 E CO RD 150 SOUTH
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8190
Practice Address - Country:US
Practice Address - Phone:317-837-8900
Practice Address - Fax:317-837-8908
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009587122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN861062947OtherTAX ID #