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General NPI Number Information
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NPI Number | 1245696467
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Entity Type | Organization
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Legal Business Name | GARY L GIANGRECO DDC PC
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Dates
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Enumeration Date | 01/04/2016
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Last Update Date | 01/04/2016
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Provider Practice Location Address
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Address Line | 2115 EMPIRE BLVD
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City | WEBSTER
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State | NY
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Zip | 14580-1907
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Country | US
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Telephone | 585-671-4522
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Fax |
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Provider Business Mailing Address
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Address Line | 2115 EMPIRE BLVD
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City | WEBSTER
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State | NY
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Zip | 14580-1907
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GARY L GIANGRECO
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Credential | DDC PC
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Telephone | 585-671-4522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 043501
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License Number State | NY
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