MEDICARE: GREGORY P. THURSTON DDS, A PROFESSIONAL CORPORATION

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

General Provider Information

NPI Number	:	1730727884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREGORY P. THURSTON DDS, A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	1486 PALM ST
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93401-2938
Country	:	US
Telephone Number	:	805-550-5885
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	:	805-550-5885
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. GREGORY PEARCE THURSTON
Credential	:	DDS
Telephone Number	:	805-550-5885

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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