Healthcare Provider Details

I. General information

NPI: 1588661730
Provider Name (Legal Business Name): GREGORY CARL TINLOY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 03/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 PRISON RD.
REPRESA CA
95671
US

IV. Provider business mailing address

PO BOX 29 100 PRISON RD.
REPRESA CA
95671
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-8610
  • Fax:
Mailing address:
  • Phone: 916-985-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30973
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30973
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: