Provider Demographics
NPI:1356533350
Name:GRECO, STEVEN (MS, DMD)
Entity type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:
Last Name:GRECO
Suffix:
Gender:M
Credentials:MS, DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07102-1215
Mailing Address - Country:US
Mailing Address - Phone:973-622-3614
Mailing Address - Fax:973-622-1710
Practice Address - Street 1:573 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102-1215
Practice Address - Country:US
Practice Address - Phone:973-622-3614
Practice Address - Fax:973-622-1710
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013723001223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223P0700XDental ProvidersDentistProsthodontics