Provider Demographics
NPI:1043337694
Name:LORD, GREGORY (DMD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:LORD
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 1:3841 RUCKRIEGEL PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3986
Mailing Address - Country:US
Mailing Address - Phone:502-267-4141
Mailing Address - Fax:502-267-5952
Practice Address - Street 1:3841 RUCKRIEGEL PKWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3986
Practice Address - Country:US
Practice Address - Phone:502-267-4141
Practice Address - Fax:502-267-5952
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019026521122300000X
KY7950122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist