Provider Demographics
NPI:1184708489
Name:LONGMEIER, GREGG (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:LONGMEIER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16008 N DALTON RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-9758
Mailing Address - Country:US
Mailing Address - Phone:509-466-1951
Mailing Address - Fax:509-466-4553
Practice Address - Street 1:10103 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1380
Practice Address - Country:US
Practice Address - Phone:509-467-1562
Practice Address - Fax:509-467-1740
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000042501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE00004230OtherDENTIST