Organization
TANNER B. GREGORY, D.D.S.,P.L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIM WIDEMAN (OFFICE MANAGER/BOOKKEEPER)
(806) 792-4889
Entity
Organization
Contact information
Practice address
3302 64TH ST STE B, LUBBOCK, TX 79413-5743
(806) 792-4889
Mailing address
3302 64TH ST STE B, LUBBOCK, TX 79413-5743
(806) 792-4889
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
12/30/2021
Last updated
12/30/2021
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