Provider Demographics
NPI:1386720605
Name:GREECE ORAL SURGERY, P.C.
Entity type:Organization
Organization Name:GREECE ORAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:585-227-0800
Mailing Address - Street 1:2081 RIDGE RD W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2724
Mailing Address - Country:US
Mailing Address - Phone:585-227-0800
Mailing Address - Fax:585-227-0802
Practice Address - Street 1:2081 RIDGE RD W
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2724
Practice Address - Country:US
Practice Address - Phone:585-227-0800
Practice Address - Fax:585-227-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-29
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210878DA1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1245Medicare PIN