Provider Demographics
NPI:1821148271
Name:JAMES A. GRIECO D.D.S., PC
Entity Type:Organization
Organization Name:JAMES A. GRIECO D.D.S., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:GRIECO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-445-9545
Mailing Address - Street 1:11051 S FAIRFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-1813
Mailing Address - Country:US
Mailing Address - Phone:773-445-9545
Mailing Address - Fax:773-445-9783
Practice Address - Street 1:11051 S FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-1813
Practice Address - Country:US
Practice Address - Phone:773-445-9545
Practice Address - Fax:773-445-9783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$OtherSSN