Provider Demographics
NPI:1316017379
Name:GRIESER, PETER A (DDS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:GRIESER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 POTTERY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-2518
Mailing Address - Country:US
Mailing Address - Phone:360-895-4321
Mailing Address - Fax:
Practice Address - Street 1:1880 POTTERY AVE STE 200
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-2518
Practice Address - Country:US
Practice Address - Phone:360-895-4321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA70161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice