MEDICARE: DR. EDWARD J MCGREEVEY DMD MSD

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	1223E0200X	Endodontics	D011582	AZ

General Provider Information

NPI Number	:	1184633000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD J MCGREEVEY DMD MSD

Provider Business Mailing Address
First Line	:	19389 N 59TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-6500
Country	:	US
Telephone Number	:	623-806-7725
Fax Number	:	623-537-6013

Provider Business Practice Location Address
First Line	:	5855 W UTOPIA RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85308-5251
Country	:	US
Telephone Number	:	623-537-6000
Fax Number	:	623-806-7010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	09/21/2022

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