Healthcare Provider Details

I. General information

NPI: 1376725051
Provider Name (Legal Business Name): JERRY L GREER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 06/08/2009
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 TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number5797
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number3693
License Number StateOK

VIII. Authorized Official

Name: JERRY L GREER
Title or Position: SURGEON
Credential: DDS
Phone: 918-747-4760