Provider Demographics
NPI:1750444030
Name:GRECO, JOAN M (DDS)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
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 1:65-1230 MAMALAHOA HWY STE C10
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-8445
Mailing Address - Country:US
Mailing Address - Phone:808-885-9000
Mailing Address - Fax:
Practice Address - Street 1:65-1230 MAMALAHOA HWY STE C10
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8445
Practice Address - Country:US
Practice Address - Phone:808-885-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 18131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI03442901Medicaid
HI38042OtherHMSA AND BCBS
HIU52737Medicare UPIN
HI03442901Medicaid