Provider Demographics
NPI:1578695375
Name:GRIEGO, ROBERT GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:GENE
Last Name:GRIEGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4025 WEST BELL RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85053
Mailing Address - Country:US
Mailing Address - Phone:602-978-4400
Mailing Address - Fax:602-978-3162
Practice Address - Street 1:4025 WEST BELL RD
Practice Address - Street 2:SUITE 13
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85053
Practice Address - Country:US
Practice Address - Phone:602-978-4400
Practice Address - Fax:602-978-3162
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ15391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice