Provider Demographics
NPI:1386751311
Name:GREAVES, DAVID EARL (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:EARL
Last Name:GREAVES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 BUTLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-3717
Mailing Address - Country:US
Mailing Address - Phone:314-892-8060
Mailing Address - Fax:314-892-8806
Practice Address - Street 1:4305 BUTLER HILL RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-3717
Practice Address - Country:US
Practice Address - Phone:314-892-8060
Practice Address - Fax:314-892-8806
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0144921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice