Provider Demographics
NPI:1528193000
Name:LOMBARDO, GREGG
Entity Type:Individual
Prefix:
First Name:GREGG
Middle Name:
Last Name:LOMBARDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28401-7506
Mailing Address - Country:US
Mailing Address - Phone:910-762-1555
Mailing Address - Fax:910-251-1721
Practice Address - Street 1:1510 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28401-7506
Practice Address - Country:US
Practice Address - Phone:910-762-1555
Practice Address - Fax:910-251-1721
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC63591223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCU87842Medicare UPIN