Provider Demographics
NPI:1568507630
Name:GRIECO, JOSEPH P JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:GRIECO
Suffix:JR
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 1:3541 CHAIN BRIDGE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2793
Mailing Address - Country:US
Mailing Address - Phone:703-385-9700
Mailing Address - Fax:703-385-9703
Practice Address - Street 1:3541 CHAIN BRIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-2793
Practice Address - Country:US
Practice Address - Phone:703-385-9700
Practice Address - Fax:703-385-9703
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA60711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016309OtherANTHEM PROVIDER NUMBER
VA0620746OtherUNITED CONCORDIA PROVIDER