Healthcare Provider Details

I. General information

NPI: 1396960589
Provider Name (Legal Business Name): GRECO OCCHIPINTI DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1777 KLOCKNER RD
MERCERVILLE NJ
08619-2725
US

IV. Provider business mailing address

1777 KLOCKNER RD
MERCERVILLE NJ
08619-2725
US

V. Phone/Fax

Practice location:
  • Phone: 609-586-2865
  • Fax:
Mailing address:
  • Phone: 609-586-2865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number14962
License Number StateNJ

VIII. Authorized Official

Name: MARK GRECO
Title or Position: PRESIDENT
Credential: DMD
Phone: 609-586-2865