Healthcare Provider Details

I. General information

NPI: 1164527420
Provider Name (Legal Business Name): TONY BRANDON GREER DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1938 LYDA AVE
BOWLING GREEN KY
42104-3326
US

IV. Provider business mailing address

1938 LYDA AVE
BOWLING GREEN KY
42104-3326
US

V. Phone/Fax

Practice location:
  • Phone: 270-783-0064
  • Fax: 270-901-1997
Mailing address:
  • Phone: 270-783-0064
  • Fax: 270-901-1997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number8335
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number904
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: