{
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"OrgName": "GREGG R KOLEBUCK DDS LTD",
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "1811 S RAINBOW BLVD STE 202",
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"MailingAddressCityName": "LAS VEGAS",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89146-0855",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "702-838-5400",
"MailingAddressFaxNumber": "702-838-5031",
"FirstLinePracticeLocationAddress": "1811 S RAINBOW BLVD STE 202",
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"PracticeLocationAddressCityName": "LAS VEGAS",
"PracticeLocationAddressStateName": "NV",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "702-838-5400",
"PracticeLocationAddressFaxNumber": "702-838-5031",
"EnumerationDate": "04/12/2007",
"LastUpdateDate": "03/19/2019",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOLEBUCK",
"AuthorizedOfficialFirstName": "GREGG",
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"AuthorizedOfficialNamePrefix": "DR.",
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"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "702-838-5400",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "332BC3200X",
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "N"
},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}