MEDICARE: DR. GREGORY SILEO 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	DN123441	GA

General Provider Information

NPI Number	:	1992541122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY SILEO DMD

Provider Business Mailing Address
First Line	:	5462 WHITTLESEY BLVD APT 507
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3158
Country	:	US
Telephone Number	:	860-480-2114
Fax Number	:

Provider Business Practice Location Address
First Line	:	6998 OLD CUSSETA RD
Second Line	:
City	:	FORT MOORE
State	:	GA
Zip	:	31905-5431
Country	:	US
Telephone Number	:	860-480-2114
Fax Number	:

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

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/12/2024

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