=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902935000
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VICTOR L. GREGORY, JR.,D.M.D.,P.A.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 04/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5301 LIMESTONE RD SUITE #211
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-1250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-239-1827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5301 LIMESTONE RD SUITE #211
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19808-1250
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-239-1827
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EMPLOYER
-----------------------------------------------------
Name | DR. VICTOR L. GREGORY JR.
-----------------------------------------------------
Credential | D.M.D.
-----------------------------------------------------
Telephone | 302-239-1827
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | G10001003
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------