Provider Demographics
NPI:1124203203
Name:GREGORY KEVIN GOR, P.A.
Entity Type:Organization
Organization Name:GREGORY KEVIN GOR, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/EXECUTIVE
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:GOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-240-2545
Mailing Address - Street 1:14881 SOUTHWEST FWY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14881 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5016
Practice Address - Country:US
Practice Address - Phone:281-240-2545
Practice Address - Fax:281-240-2544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX204851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB20485OtherCHIP