MEDICARE: GREECE PEDIATRIC DENTISTRY, LLP

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	1223P0221X	Pediatric Dentistry	035018-1	NY

General Provider Information

NPI Number	:	1548339963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREECE PEDIATRIC DENTISTRY, LLP

Provider Business Mailing Address
First Line	:	2061 RIDGE ROAD WEST
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2782
Country	:	US
Telephone Number	:	585-227-4570
Fax Number	:	585-227-5410

Provider Business Practice Location Address
First Line	:	2061 RIDGE RD W
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2718
Country	:	US
Telephone Number	:	585-227-4570
Fax Number	:	585-227-5410

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	DR. DAVID P. DURR
Credential	:	D.M.D.
Telephone Number	:	585-227-4570

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	08/22/2020

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