Provider Demographics
NPI:1316921745
Name:BESS, GREGORY CHARLES (MD, DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CHARLES
Last Name:BESS
Suffix:
Gender:M
Credentials:MD, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 N CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3828
Mailing Address - Country:US
Mailing Address - Phone:334-671-5790
Mailing Address - Fax:334-792-9336
Practice Address - Street 1:216 HEALTHWEST DR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1942
Practice Address - Country:US
Practice Address - Phone:334-792-2880
Practice Address - Fax:334-792-9336
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL153641223S0112X
AL40711223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL768972OtherUNITED CONCORDIA
AL51097745OtherBCBSAL ENTERPRISE OFFICE
AL000090976Medicaid
AL51090976OtherBCBSAL DOTHAN OFFICE
AL768972OtherUNITED CONCORDIA
AL000090976Medicaid