Provider Demographics
NPI:1356676779
Name:GRECO, CHRISTINE C (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:C
Last Name:GRECO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CHRISTINE
Other - Middle Name:C
Other - Last Name:GUANLAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:304 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2427
Mailing Address - Country:US
Mailing Address - Phone:973-239-0032
Mailing Address - Fax:
Practice Address - Street 1:304 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NJ
Practice Address - Zip Code:07044-2427
Practice Address - Country:US
Practice Address - Phone:973-239-0032
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-04
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02423500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist