Provider Demographics
NPI:1952340010
Name:GRECO, CLIFFORD ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLIFFORD
Middle Name:ALAN
Last Name:GRECO
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 1:4100 DUFF PL
Mailing Address - Street 2:SUITE G-1
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1324
Mailing Address - Country:US
Mailing Address - Phone:516-796-8100
Mailing Address - Fax:
Practice Address - Street 1:4100 DUFF PL
Practice Address - Street 2:SUITE G-1
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1324
Practice Address - Country:US
Practice Address - Phone:516-796-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0313141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice