MEDICARE: GREGORY PO 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	1223G0001X	General Practice Dentistry	4425	NV

General Provider Information

NPI Number	:	1639361843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY PO DDS

Provider Business Mailing Address
First Line	:	5001 E BONANZA RD
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3557
Country	:	US
Telephone Number	:	702-307-2273
Fax Number	:	702-307-2275

Provider Business Practice Location Address
First Line	:	5001 E BONANZA RD
Second Line	:	SUITE 160
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3557
Country	:	US
Telephone Number	:	702-307-2273
Fax Number	:	702-307-2275

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

Provider Enumeration Date	:	08/11/2007
Last Update Date	:	08/11/2007

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Directions to “ GREGORY PO DDS” Practice Location

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