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NPI Code Detail

MEDICARE: DR. JEFFREY ALAN GREENE D.D.S.

MEDICARE: DR. JEFFREY ALAN GREENE D.D.S.
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
11223X0400XOrthodontics and Dentofacial Orthopedics Dentistry19739CA

General Provider Information

NPI Number : 1700060936
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY ALAN GREENE D.D.S.
Provider Business Mailing Address
First Line : 715 S MAIN ST
Second Line : 2
City : SANTA ANA
State : CA
Zip : 92701-5717
Country : US
Telephone Number : 714-647-0797
Fax Number :
Provider Business Practice Location Address
First Line : 715 S MAIN ST
Second Line : 2
City : SANTA ANA
State : CA
Zip : 92701-5717
Country : US
Telephone Number : 714-647-0797
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/24/2007
Last Update Date : 12/24/2007

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