Provider Demographics
NPI:1669491064
Name:LISS, GREGORY STEPHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:STEPHEN
Last Name:LISS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LITTLE FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-1732
Mailing Address - Country:US
Mailing Address - Phone:973-256-5001
Mailing Address - Fax:973-256-8179
Practice Address - Street 1:159 EAST MAIN ST
Practice Address - Street 2:
Practice Address - City:LITTLE FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07424-1732
Practice Address - Country:US
Practice Address - Phone:973-256-5001
Practice Address - Fax:973-256-8179
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI01742700122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist