Provider Demographics
NPI:1528237641
Name:GREGORY N DAY DDS ORAL SURGURY PC
Entity type:Organization
Organization Name:GREGORY N DAY DDS ORAL SURGURY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:NELSON
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS/OMS
Authorized Official - Phone:719-561-2440
Mailing Address - Street 1:3902 SANDLEWOOD LN
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-7501
Mailing Address - Country:US
Mailing Address - Phone:719-561-2440
Mailing Address - Fax:719-561-0612
Practice Address - Street 1:3902 SANDLEWOOD LN
Practice Address - Street 2:SUITE 110
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-7501
Practice Address - Country:US
Practice Address - Phone:719-561-2440
Practice Address - Fax:719-561-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO65631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08328544Medicaid
CO08328544Medicaid