Provider Demographics
NPI:1093236887
Name:GREGORY W. CECIL, DMD, LLC
Entity Type:Organization
Organization Name:GREGORY W. CECIL, DMD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CECIL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:502-955-8845
Mailing Address - Street 1:11302 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2862
Mailing Address - Country:US
Mailing Address - Phone:502-955-8845
Mailing Address - Fax:502-969-4634
Practice Address - Street 1:11302 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-2862
Practice Address - Country:US
Practice Address - Phone:502-955-8845
Practice Address - Fax:502-969-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5546261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental