Provider Demographics
NPI:1073819405
Name:MCGREGOR-WILTZ, PRECIOUS MONTEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRECIOUS
Middle Name:MONTEY
Last Name:MCGREGOR-WILTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:P
Other - Middle Name:M
Other - Last Name:MCGREGOR-WILTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:158 30TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70124-1330
Mailing Address - Country:US
Mailing Address - Phone:504-444-5236
Mailing Address - Fax:
Practice Address - Street 1:600 N HIGHWAY 190
Practice Address - Street 2:SUITE 4
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-5003
Practice Address - Country:US
Practice Address - Phone:985-893-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist