Healthcare Provider Details

I. General information

NPI: 1316932973
Provider Name (Legal Business Name): JERRY L GREER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 E 21ST ST
TULSA OK
74114-1409
US

IV. Provider business mailing address

2105 E 21ST ST
TULSA OK
74114-1409
US

V. Phone/Fax

Practice location:
  • Phone: 918-747-4760
  • Fax: 918-747-6731
Mailing address:
  • Phone: 918-747-4760
  • Fax: 918-747-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3693
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: