Provider Demographics
NPI:1104154749
Name:CYNTHIA GREGORY DMD PC
Entity type:Organization
Organization Name:CYNTHIA GREGORY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:702-423-0443
Mailing Address - Street 1:7520 W WASHINGTON AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4332
Mailing Address - Country:US
Mailing Address - Phone:702-363-1590
Mailing Address - Fax:702-363-1172
Practice Address - Street 1:7520 W WASHINGTON AVE STE 120
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4332
Practice Address - Country:US
Practice Address - Phone:702-363-1590
Practice Address - Fax:702-363-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV55211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty