MEDICARE: MRS. CYNTHIA ANN GREGORY DMD

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	5521	NV

General Provider Information

NPI Number	:	1821285214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA ANN GREGORY DMD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2007
Last Update Date	:	11/19/2009

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