Provider Demographics
NPI:1376262907
Name:GRIECO, PAULA DANELLE
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:DANELLE
Last Name:GRIECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1758 N BUNDY AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8151
Mailing Address - Country:US
Mailing Address - Phone:559-283-5001
Mailing Address - Fax:
Practice Address - Street 1:1315 SHAW AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-3961
Practice Address - Country:US
Practice Address - Phone:559-321-0886
Practice Address - Fax:559-547-3194
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA913124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist