Organization
GREGORY R. ERENA, P.S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY R ERENA DMD (PRESIDENT)
(859) 268-4423
Entity
Organization
Contact information
Practice address
620 PERIMETER DR, STE 100, LEXINGTON, KY 40517-4125
(859) 268-4423
(859) 268-0010
Mailing address
620 PERIMETER DR, STE 100, LEXINGTON, KY 40517-4125
(859) 268-4423
(859) 268-0010
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3978
MEDICARE GROUP
KY
05
—
61900486
—
KY
05
—
65936221
—
KY
Enumeration date
07/05/2005
Last updated
03/20/2009
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