Provider Demographics
NPI:1366435349
Name:VANNUCCI, GREGORY P (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:VANNUCCI
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 1:1116 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2109
Mailing Address - Country:US
Mailing Address - Phone:641-682-2350
Mailing Address - Fax:641-683-4616
Practice Address - Street 1:1116 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2109
Practice Address - Country:US
Practice Address - Phone:641-682-2350
Practice Address - Fax:641-683-4616
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:2006-03-27
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
IA079631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery