MEDICARE: BARRY J. GREYSON DMD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1063749133
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARRY J. GREYSON DMD INC

Provider Business Mailing Address
First Line	:	2120 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2402
Country	:	US
Telephone Number	:	140-552-5688
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 NW 23RD ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-2402
Country	:	US
Telephone Number	:	140-552-5688
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BARRY J GREYSON
Credential	:	DMD
Telephone Number	:	14055256882

Provider Enumeration Date	:	11/11/2009
Last Update Date	:	11/11/2009

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