Healthcare Provider Details

I. General information

NPI: 1356519169
Provider Name (Legal Business Name): DR. PETER GRECO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

834 CHESTNUT ST M209
PHILADELPHIA PA
19107-5127
US

IV. Provider business mailing address

834 CHESTNUT ST M209
PHILADELPHIA PA
19107-5127
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-8802
  • Fax: 215-955-4997
Mailing address:
  • Phone: 215-955-8802
  • Fax: 215-955-4997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS021284L
License Number StatePA

VIII. Authorized Official

Name: MRS. PATRICIA A NORRIS
Title or Position: OFFICE MANAGER
Credential:
Phone: 215-955-8802