Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 034956 | CA |
NPI | 1134241870 |
---|---|
Provider Name | Gregg S Filippelli |
First Address | Rancho Cucamonga, CA 91730-6805 |
Second Address | Rancho Cucamonga, CA 91730-6805 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |