Healthcare Provider Details

I. General information

NPI: 1386720605
Provider Name (Legal Business Name): GREECE ORAL SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2006
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2081 RIDGE RD W SUITE 101
ROCHESTER NY
14626-2724
US

IV. Provider business mailing address

2081 RIDGE RD W SUITE 101
ROCHESTER NY
14626-2724
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-0800
  • Fax: 585-227-0802
Mailing address:
  • Phone: 585-227-0800
  • Fax: 585-227-0802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number210878DA
License Number StateNY

VIII. Authorized Official

Name: DR. DAVID LEE ANDERSON
Title or Position: OWNER
Credential: D.D.S., M.D.
Phone: 585-227-0800