Provider Demographics
NPI:1639141864
Name:GREGOR, VICTOR (DENTIST DMD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:GREGOR
Suffix:
Gender:M
Credentials:DENTIST DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W ENT AVE
Mailing Address - Street 2:21ST DENTAL SQUADRON
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80914-1595
Mailing Address - Country:US
Mailing Address - Phone:719-556-1334
Mailing Address - Fax:719-556-1331
Practice Address - Street 1:110 W ENT AVE
Practice Address - Street 2:21ST DENTAL SQUADRON
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80914-1595
Practice Address - Country:US
Practice Address - Phone:719-556-1334
Practice Address - Fax:719-556-1331
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4374122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist