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General NPI Number Information
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NPI Number | 1376725051
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Entity Type | Organization
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Legal Business Name | JERRY L GREER DDS PC
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 2105 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1409
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Country | US
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Telephone | 918-747-4760
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Fax | 918-747-6731
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Provider Business Mailing Address
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Address Line | 2105 E 21ST ST
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City | TULSA
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State | OK
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Zip | 74114-1409
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Country | US
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Telephone | 918-747-4760
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Fax | 918-747-6731
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Authorized Official
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Title or Position | SURGEON
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Name | JERRY L GREER
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Credential | DDS
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Telephone | 918-747-4760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 5797
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 3693
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License Number State | OK
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