Healthcare Provider Details

I. General information

NPI: 1184633000
Provider Name (Legal Business Name): EDWARD J MCGREEVEY DMD MSD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 W UTOPIA RD
GLENDALE AZ
85308-5251
US

IV. Provider business mailing address

19389 N 59TH AVE
GLENDALE AZ
85308-6500
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6000
  • Fax: 623-806-7010
Mailing address:
  • Phone: 623-806-7725
  • Fax: 623-537-6013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberD011582
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: