Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DS021284L | PA |
NPI | 1073556494 |
---|---|
Provider Name | Dr. Peter Michael Greco |
First Address | Philadelphia, PA 19107-5127 |
Second Address | Philadelphia, PA 19107-5127 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 14/10/2008 |