MEDICARE: CYNTHIA GREGORY DMD PC

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	1223G0001X	General Practice Dentistry	5521	NV

General Provider Information

NPI Number	:	1104154749
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYNTHIA GREGORY DMD PC

Provider Business Mailing Address
First Line	:	7520 W WASHINGTON AVE STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4332
Country	:	US
Telephone Number	:	702-363-1590
Fax Number	:	702-363-1172

Provider Business Practice Location Address
First Line	:	7520 W WASHINGTON AVE STE 120
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-4332
Country	:	US
Telephone Number	:	702-363-1590
Fax Number	:	702-363-1172

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. CYNTHIA ANN GREGORY
Credential	:	DMD
Telephone Number	:	702-423-0443

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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