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General NPI Number Information
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NPI Number | 1124900311
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Entity Type | Organization
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Legal Business Name | GREESIM LOY DDS, PROFESSIONAL DENTAL LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 07/21/2025
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Last Update Date | 07/21/2025
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Provider Practice Location Address
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Address Line | 13730 MILLERVILLE GREENS BLVD # 1
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City | BATON ROUGE
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State | LA
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Zip | 70816-1696
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Country | US
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Telephone | 225-234-0713
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70887
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City | CLEVELAND
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State | OH
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Zip | 44190-0887
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Country | US
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Telephone | 315-454-6000
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT MANAGER
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Name | CHRISTINE BARBER
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Credential |
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Telephone | 315-454-6000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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