Tidwell, Gregg Carrington
Tidwell, Gregg Carrington is an sole proprietor health care provider with primary practice located at 1512 Royal Ave , Monroe LA 71201-5610. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Tidwell, Gregg Carrington can be contacted via phone (318) 387-5400.Contact Information
Primary practice address
1512 Royal Ave
Monroe LA 71201-5610
Phone: (318) 387-5400
Fax: (318) 387-5440
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | 3793 | Louisiana |
Profile Details
| NPI number | 1639223043 |
|---|---|
| LBN Legal business name | Tidwell, Gregg Carrington |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 23rd, 2007 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639223043 | NPPES |
| Louisiana | MEDICAID | 1837938 |
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