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General NPI Number Information
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NPI Number | 1326241894
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Entity Type | Individual
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Provider Name | JEFFREY BRYAN GREENE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 10543 E CORTEZ DR
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City | SCOTTSDALE
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State | AZ
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Zip | 85259-2938
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Country | US
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Telephone | 480-837-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 12625 N. SAGUARO BLVD SUITE 108
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268
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Country | US
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Telephone | 480-837-8100
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D6539
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License Number State | AZ
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