=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891903977
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERTA H MCGREGOR DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10700 MONTGOMERY RD SUITE 220
-----------------------------------------------------
City | MONTGOMERY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45242-3255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-793-8899
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10361 GIVERNY BLVD
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45241-3280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-733-0552
-----------------------------------------------------
Fax | 513-733-8660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 30018816
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------