Provider Demographics
NPI:1548347941
Name:GRESHAM, DAVID L (DDS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:GRESHAM
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 1:2800 PARK AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3375
Mailing Address - Country:US
Mailing Address - Phone:209-383-3403
Mailing Address - Fax:209-383-3895
Practice Address - Street 1:2800 PARK AVE
Practice Address - Street 2:STE. B
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-3375
Practice Address - Country:US
Practice Address - Phone:209-383-3403
Practice Address - Fax:209-383-3895
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice