Provider Demographics
NPI:1588878789
Name:KOLEBUCK, GREGG R (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGG
Middle Name:R
Last Name:KOLEBUCK
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 1:1811 S RAINBOW BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0855
Mailing Address - Country:US
Mailing Address - Phone:702-838-5400
Mailing Address - Fax:702-838-5031
Practice Address - Street 1:1811 S RAINBOW BLVD STE 202
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0855
Practice Address - Country:US
Practice Address - Phone:702-838-5400
Practice Address - Fax:702-838-5031
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3337122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist