Healthcare Provider Details

I. General information

NPI: 1548339963
Provider Name (Legal Business Name): GREECE PEDIATRIC DENTISTRY, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2061 RIDGE RD W
ROCHESTER NY
14626-2718
US

IV. Provider business mailing address

2061 RIDGE ROAD WEST
ROCHESTER NY
14626-2782
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-4570
  • Fax: 585-227-5410
Mailing address:
  • Phone: 585-227-4570
  • Fax: 585-227-5410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number035018-1
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID P. DURR
Title or Position: MANAGING PARTNER
Credential: D.M.D.
Phone: 585-227-4570