Provider Demographics
NPI:1134133663
Name:GRECO, EUGENE CARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:CARL
Last Name:GRECO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-3336
Mailing Address - Country:US
Mailing Address - Phone:631-283-1040
Mailing Address - Fax:631-283-1105
Practice Address - Street 1:64 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-3336
Practice Address - Country:US
Practice Address - Phone:631-283-1040
Practice Address - Fax:631-283-1105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0420571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice