MEDICARE: DR. GREGORY PEARCE THURSTON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	61788	CA

General Provider Information

NPI Number	:	1013261494
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY PEARCE THURSTON DDS

Provider Business Mailing Address
First Line	:	1486 PALM ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2938
Country	:	US
Telephone Number	:	805-543-8675
Fax Number	:

Provider Business Practice Location Address
First Line	:	1486 PALM ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2938
Country	:	US
Telephone Number	:	805-543-8675
Fax Number	:	805-543-8696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2012
Last Update Date	:	10/05/2021

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