# GREGG R KOLEBUCK DDS LTD

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lake Sahara Dental
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164646295
- **Authorized official:** DR. GREGG R KOLEBUCK DDS (DENTIST / OWNER)
- **Authorized official phone:** (702) 838-5400

## Contact information

- **Practice address:** 1811 S RAINBOW BLVD STE 202, LAS VEGAS, NV 89146-0855
- **Practice address phone:** (702) 838-5400
- **Practice address fax:** (702) 838-5031
- **Mailing address:** 1811 S RAINBOW BLVD STE 202, LAS VEGAS, NV 89146-0855
- **Mailing address phone:** (702) 838-5400
- **Mailing address fax:** (702) 838-5031

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 3337 | NV | Yes |
| 332BC3200X | Customized Equipment (DME) | — | NULL | — |

## Other

- **Enumeration date:** 04/12/2007
- **Last updated:** 03/19/2019