Provider Demographics
NPI:1447392626
Name:GRECO, LAURA J
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:J
Last Name:GRECO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HAZEL STREET
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-5715
Mailing Address - Country:US
Mailing Address - Phone:203-576-4138
Mailing Address - Fax:203-576-4220
Practice Address - Street 1:30 HAZEL STREET
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-5715
Practice Address - Country:US
Practice Address - Phone:203-576-4137
Practice Address - Fax:203-576-4220
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003579124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist