Provider Demographics
NPI:1558562108
Name:GRECI, VINCENT J (DDS)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:GRECI
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 1:13038 S LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1719
Mailing Address - Country:US
Mailing Address - Phone:708-361-9656
Mailing Address - Fax:708-361-6442
Practice Address - Street 1:13038 S LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1719
Practice Address - Country:US
Practice Address - Phone:708-361-9656
Practice Address - Fax:708-361-6442
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice