Provider Demographics
NPI:1457094773
Name:GRASSI DDS PC
Entity Type:Organization
Organization Name:GRASSI DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-729-6206
Mailing Address - Street 1:1103 SIDNEY ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-1719
Mailing Address - Country:US
Mailing Address - Phone:315-729-6206
Mailing Address - Fax:
Practice Address - Street 1:6789 E GENESEE ST # 1B
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1640
Practice Address - Country:US
Practice Address - Phone:315-729-6206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-14
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental