Provider Demographics
NPI:1124167150
Name:GRIEGO, ALEX RYAN (DDS)
Entity type:Individual
Prefix:
First Name:ALEX RYAN
Middle Name:
Last Name:GRIEGO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S 4TH ST UNIT 904
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-2471
Mailing Address - Country:US
Mailing Address - Phone:505-480-8033
Mailing Address - Fax:
Practice Address - Street 1:10750 W MCDOWELL RD STE F610
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-5976
Practice Address - Country:US
Practice Address - Phone:623-474-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD0089951223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry