Individual
DR. GREG S TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
508 RUSSELL BLVD, NACOGDOCHES, TX 75965-1244
(936) 569-1111
Mailing address
508 RUSSELL BLVD, NACOGDOCHES, TX 75965-1244
(936) 569-1111
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
16877
TX
Other
Enumeration date
03/17/2006
Last updated
06/15/2009
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