Healthcare Provider Details

I. General information

NPI: 1336590785
Provider Name (Legal Business Name): GREGORY GARRETT SERRANO DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

646 SWIFT RD
WEST POINT NY
10996-1942
US

IV. Provider business mailing address

646 SWIFT RD
WEST POINT NY
10996-1942
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-4611
  • Fax:
Mailing address:
  • Phone: 845-938-4611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857303
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: