Provider Demographics
NPI:1194379776
Name:GREER MCNAMARA DDS PLLC
Entity type:Organization
Organization Name:GREER MCNAMARA DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-591-0551
Mailing Address - Street 1:6825 BURDEN BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-5633
Mailing Address - Country:US
Mailing Address - Phone:509-591-0551
Mailing Address - Fax:
Practice Address - Street 1:6825 BURDEN BLVD STE B
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-5633
Practice Address - Country:US
Practice Address - Phone:509-591-0551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCNAMARA DDS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2072517Medicaid