Healthcare Provider Details

I. General information

NPI: 1043337694
Provider Name (Legal Business Name): GREGORY LORD DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5835 E STILL CIR
MESA AZ
85206-3618
US

IV. Provider business mailing address

5835 E STILL CIR
MESA AZ
85206-3618
US

V. Phone/Fax

Practice location:
  • Phone: 480-248-8100
  • Fax:
Mailing address:
  • Phone: 480-248-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number019026521
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7950
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10504
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: