Healthcare Provider Details

I. General information

NPI: 1235810300
Provider Name (Legal Business Name): JAYLEN E GREER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 944
BRANDON SUFFOLK
IP27 9PN
GB

IV. Provider business mailing address

PSC 41 BOX 4845
APO AE
09464-0049
US

V. Phone/Fax

Practice location:
  • Phone: 774-786-9294
  • Fax:
Mailing address:
  • Phone: 774-786-9294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: