Basic Information
| Provider Information | |||||||||
| NPI: | 1982685749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLYTHE | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | US ARMY DENTAL ACTIVITY HAWAII | ||||||||
| Address2: | 1 JARRETT WHITE ROAD, ATTN MCDS-NH | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | 8084333928 | ||||||||
| Practice Location | |||||||||
| Address1: | US ARMY DENTAL ACTIVITY HAWAII | ||||||||
| Address2: | 1 JARRETT WHITE ROAD, ATTN MCDS-NH | ||||||||
| City: | TRIPLER AMC | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968595000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084331021 | ||||||||
| FaxNumber: | 8084333928 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 08/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223P0300X | 30017629 | OH | Y | Dental Providers | Dentist | Periodontics |
No ID Information.