Provider Demographics
NPI:1699766410
Name:GREENFIELD FAMILY DENTISTRY PC
Entity type:Organization
Organization Name:GREENFIELD FAMILY DENTISTRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HERR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-632-6999
Mailing Address - Street 1:875 N GREENFIELD RD
Mailing Address - Street 2:STE 114
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-5044
Mailing Address - Country:US
Mailing Address - Phone:480-632-6999
Mailing Address - Fax:480-632-6997
Practice Address - Street 1:875 N GREENFIELD RD
Practice Address - Street 2:STE 114
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5044
Practice Address - Country:US
Practice Address - Phone:480-632-6999
Practice Address - Fax:480-632-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD52511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty