Healthcare Provider Details

I. General information

NPI: 1841341591
Provider Name (Legal Business Name): GREELEY & NISTA ORTHODONTICS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SILVERSIDE RD
WILMINGTON DE
19810-4445
US

IV. Provider business mailing address

1405 SILVERSIDE RD
WILMINGTON DE
19810-4445
US

V. Phone/Fax

Practice location:
  • Phone: 302-475-4102
  • Fax:
Mailing address:
  • Phone: 302-475-4102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SUZANNE NISTA
Title or Position: ACCT
Credential:
Phone: 30247547102