Provider Demographics
NPI:1538383922
Name:PENCE, GREGORY DAVID (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DAVID
Last Name:PENCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 POCONO BLVD
Mailing Address - Street 2:
Mailing Address - City:MOUNT POCONO
Mailing Address - State:PA
Mailing Address - Zip Code:18344-1428
Mailing Address - Country:US
Mailing Address - Phone:570-839-6736
Mailing Address - Fax:570-839-7101
Practice Address - Street 1:201 POCONO BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT POCONO
Practice Address - State:PA
Practice Address - Zip Code:18344-1428
Practice Address - Country:US
Practice Address - Phone:570-839-6736
Practice Address - Fax:570-839-7101
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS021746L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice