Provider Demographics
NPI:1104298975
Name:FAMILY DENTISTRY, GREGORY S. DIRENZO, DMD
Entity type:Organization
Organization Name:FAMILY DENTISTRY, GREGORY S. DIRENZO, DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:DIRENZO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:540-338-6262
Mailing Address - Street 1:540 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3171
Mailing Address - Country:US
Mailing Address - Phone:540-338-6262
Mailing Address - Fax:540-338-7054
Practice Address - Street 1:540 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3171
Practice Address - Country:US
Practice Address - Phone:540-338-6262
Practice Address - Fax:540-338-7054
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:POTOMAC VALLEY DENTAL CARE,PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty