Individual
GREGORY WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
865 N ARIZOLA RD, CASA GRANDE, AZ 85122-6011
(520) 836-3446
(520) 836-8807
Mailing address
PO BOX 10097, CASA GRANDE, AZ 85130-0020
(520) 836-3446
(520) 836-8807
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3725
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3725
LICENSE
AZ
01
—
93170
AHCCCS
AZ
Enumeration date
07/07/2005
Last updated
12/22/2016
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