Provider Demographics
NPI:1740416882
Name:GRECO, BRANDY MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRANDY
Middle Name:MARIE
Last Name:GRECO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 S HEBRON AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-4081
Mailing Address - Country:US
Mailing Address - Phone:812-473-1900
Mailing Address - Fax:
Practice Address - Street 1:960 S HEBRON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-4081
Practice Address - Country:US
Practice Address - Phone:812-473-1900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011290A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist