NPIMap

Organization Active NPI

Gregg R Kolebuck DDS LTD

Doing business as Lake Sahara Dental

  • General Practice Dentistry
  • Las Vegas, NV
National Provider Identifier
1164646295
Registry record updated Mar 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3337 Issued in NV
Legal business name
GREGG R KOLEBUCK DDS LTD
Doing business as
Lake Sahara Dental
Practice address
1811 S Rainbow Blvd Ste 202
Las Vegas, NV 89146-0855
Phone
(702) 838-5400
Fax
(702) 838-5031
NPI assigned
Apr 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Gregg R Kolebuck, DDSNPI 1588878789
Title
Dentist / Owner
Phone
(702) 838-5400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 3337 NV Primary
Customized Equipment (DME) 332BC3200X

Addresses

Primary practice location

1811 S Rainbow Blvd Ste 202
Las Vegas, NV 89146-0855

Mailing address

1811 S Rainbow Blvd Ste 202
Las Vegas, NV 89146-0855
Phone (702) 838-5400

Other names 1

  • Lake Sahara Dental Doing business as

National Provider Directory

National Provider Directory

Locations

1811 S Rainbow Blvd
Ste 202
Las Vegas, NV 89146
Phone (702) 838-5400

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552953600000",
    "number": "1164646295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 S RAINBOW BLVD STE 202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891460855",
            "telephone_number": "702-838-5400",
            "fax_number": "702-838-5031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 S RAINBOW BLVD STE 202",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891460855",
            "telephone_number": "702-838-5400",
            "fax_number": "702-838-5031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGG R KOLEBUCK DDS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2019-03-19",
        "status": "A",
        "authorized_official_last_name": "KOLEBUCK",
        "authorized_official_first_name": "GREGG",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DENTIST / OWNER",
        "authorized_official_telephone_number": "702-838-5400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NV",
            "license": "3337",
            "primary": true
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Sahara Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lake Sahara Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.