Provider Demographics
NPI:1134149917
Name:GRIEGO, AMALIA NICHOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:AMALIA
Middle Name:NICHOLE
Last Name:GRIEGO
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 1:316 S AUBURN ST STE 6
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-7298
Mailing Address - Country:US
Mailing Address - Phone:530-272-2692
Mailing Address - Fax:530-272-5387
Practice Address - Street 1:316 S AUBURN ST STE 6
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7298
Practice Address - Country:US
Practice Address - Phone:530-272-2692
Practice Address - Fax:530-272-5387
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47622122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist