1528237641 NPI number — GREGORY N DAY DDS ORAL SURGURY PC

Table of content: (NPI 1528237641)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528237641 NPI number — GREGORY N DAY DDS ORAL SURGURY PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREGORY N DAY DDS ORAL SURGURY PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528237641
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3902 SANDLEWOOD LN
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
PUEBLO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81005-7501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-561-2440
Provider Business Mailing Address Fax Number:
719-561-0612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3902 SANDLEWOOD LN
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81005-7501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-561-2440
Provider Business Practice Location Address Fax Number:
719-561-0612
Provider Enumeration Date:
02/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DAY
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
NELSON
Authorized Official Title or Position:
OWNER/ORAL SURGEON
Authorized Official Telephone Number:
719-561-2440

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  6563 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08328544 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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