Provider Demographics
NPI:1841341591
Name:GREELEY & NISTA ORTHODONTICS, PA
Entity type:Organization
Organization Name:GREELEY & NISTA ORTHODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCT
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:NISTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3024-754-7102
Mailing Address - Street 1:1405 SILVERSIDE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4445
Mailing Address - Country:US
Mailing Address - Phone:302-475-4102
Mailing Address - Fax:
Practice Address - Street 1:1405 SILVERSIDE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4445
Practice Address - Country:US
Practice Address - Phone:302-475-4102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty