MEDICARE: ZACHARY GREGORY

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	9884	KY

General Provider Information

NPI Number	:	1487003430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZACHARY GREGORY

Provider Business Mailing Address
First Line	:	716 2ND ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-3227
Country	:	US
Telephone Number	:	270-826-2092
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 PROFESSIONAL BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47714-8010
Country	:	US
Telephone Number	:	812-437-1015
Fax Number	:

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

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	03/05/2020

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Directions to “ ZACHARY GREGORY ” Practice Location

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