Provider Demographics
NPI:1801089396
Name:GRIECO, PAUL DEREK (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DEREK
Last Name:GRIECO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DEREK
Other - Middle Name:PAUL
Other - Last Name:GRIECO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:3894 OLD WILLIAM PENN HWY
Mailing Address - Street 2:
Mailing Address - City:MURRYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15668-1855
Mailing Address - Country:US
Mailing Address - Phone:724-327-4130
Mailing Address - Fax:
Practice Address - Street 1:3894 OLD WILLIAM PENN HWY
Practice Address - Street 2:
Practice Address - City:MURRYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:15668-1855
Practice Address - Country:US
Practice Address - Phone:724-327-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028352L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice