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NPI Code Detail

MEDICARE: DR. GREGORY WALTER GREENWOOD D.M.D.

MEDICARE: DR. GREGORY WALTER GREENWOOD D.M.D.
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
1122300000XDentist5628NV

General Provider Information

NPI Number : 1275729667
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GREGORY WALTER GREENWOOD D.M.D.
Provider Business Mailing Address
First Line : 1115 WEBER ST
Second Line :
City : FRANKLIN
State : LA
Zip : 70538-4124
Country : US
Telephone Number : 337-828-2550
Fax Number : 337-355-2335
Provider Business Practice Location Address
First Line : 10870 W CHARLESTON BLVD STE 170
Second Line :
City : LAS VEGAS
State : NV
Zip : 89135-1170
Country : US
Telephone Number : 702-254-6412
Fax Number : 702-254-9558
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2007
Last Update Date : 05/25/2022

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