Provider Demographics
NPI:1346306560
Name:GARYLGIANGRECOPC
Entity Type:Organization
Organization Name:GARYLGIANGRECOPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GIANGRECO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:585-671-4522
Mailing Address - Street 1:5 WAYBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-9604
Mailing Address - Country:US
Mailing Address - Phone:585-545-5549
Mailing Address - Fax:585-671-1551
Practice Address - Street 1:2115 EMPIRE BLVD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1907
Practice Address - Country:US
Practice Address - Phone:585-671-4522
Practice Address - Fax:585-617-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043501261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental