MEDICARE: DR. HARVEY LEE GRIESNER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	031558	NY

General Provider Information

NPI Number	:	1093857567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARVEY LEE GRIESNER DDS

Provider Business Mailing Address
First Line	:	69-60 108TH STREET
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375
Country	:	US
Telephone Number	:	718-263-2694
Fax Number	:	718-263-1410

Provider Business Practice Location Address
First Line	:	69-60 108TH STREET
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-4323
Country	:	US
Telephone Number	:	718-263-2694
Fax Number	:	718-263-1410

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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