Provider Demographics
NPI:1356491807
Name:GRECO, MARIO V (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:V
Last Name:GRECO
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 1:268 ROUTE 202
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:NY
Mailing Address - Zip Code:10589-3205
Mailing Address - Country:US
Mailing Address - Phone:914-276-2099
Mailing Address - Fax:914-669-5942
Practice Address - Street 1:268 ROUTE 202
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:NY
Practice Address - Zip Code:10589-3205
Practice Address - Country:US
Practice Address - Phone:914-276-2099
Practice Address - Fax:914-669-5942
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039337-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice