Provider Demographics
NPI:1427177179
Name:GRILLO, ROBERT (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GRILLO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8404 155TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-2217
Mailing Address - Country:US
Mailing Address - Phone:718-641-7117
Mailing Address - Fax:718-641-7339
Practice Address - Street 1:8404 155TH AVE
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-2217
Practice Address - Country:US
Practice Address - Phone:718-641-7117
Practice Address - Fax:718-641-7339
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0459921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice