Provider Demographics
NPI:1003937442
Name:NUNNALLY, GREG COLE (DMD)
Entity type:Individual
Prefix:DR
First Name:GREG
Middle Name:COLE
Last Name:NUNNALLY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 DUPONT CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4824
Mailing Address - Country:US
Mailing Address - Phone:502-897-0141
Mailing Address - Fax:
Practice Address - Street 1:3935 DUPONT CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4824
Practice Address - Country:US
Practice Address - Phone:502-897-0141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY54191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice