Provider Demographics
NPI:1841340502
Name:GREGORY, VICTOR L JR (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:L
Last Name:GREGORY
Suffix:JR
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 LIMESTONE RD
Mailing Address - Street 2:SUITE #211
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-1250
Mailing Address - Country:US
Mailing Address - Phone:302-239-1827
Mailing Address - Fax:
Practice Address - Street 1:5301 LIMESTONE RD
Practice Address - Street 2:SUITE #211
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-1250
Practice Address - Country:US
Practice Address - Phone:302-239-1827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027082L1223G0001X
DEG1-00010031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE000509621OtherUCCI ID #
DE0000903708Medicaid