Provider Demographics
NPI:1902935000
Name:VICTOR L. GREGORY, JR.,D.M.D.,P.A.
Entity Type:Organization
Organization Name:VICTOR L. GREGORY, JR.,D.M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREGORY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-239-1827
Mailing Address - Street 1:5301 LIMESTONE RD
Mailing Address - Street 2:SUITE #211
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1250
Mailing Address - Country:US
Mailing Address - Phone:302-239-1827
Mailing Address - Fax:
Practice Address - Street 1:5301 LIMESTONE RD
Practice Address - Street 2:SUITE #211
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1250
Practice Address - Country:US
Practice Address - Phone:302-239-1827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG100010031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000903708Medicaid