Provider Demographics
NPI:1912091943
Name:GRECIAN, COLENE ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:COLENE
Middle Name:ANN
Last Name:GRECIAN
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 1:101 E SOUTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-4552
Mailing Address - Country:US
Mailing Address - Phone:641-753-3383
Mailing Address - Fax:641-753-8495
Practice Address - Street 1:101 E SOUTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4552
Practice Address - Country:US
Practice Address - Phone:641-753-3383
Practice Address - Fax:641-753-8495
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA78861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA709573OtherUNITED CONCORDIA
IA59289OtherDELTA DENTAL OF IOWA