Provider Demographics
NPI:1841457215
Name:JOHN B GREINER, DDS, PC
Entity type:Organization
Organization Name:JOHN B GREINER, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:GREINER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-285-1694
Mailing Address - Street 1:4214 FLEUR DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-2387
Mailing Address - Country:US
Mailing Address - Phone:515-285-1694
Mailing Address - Fax:515-285-1636
Practice Address - Street 1:4214 FLEUR DR
Practice Address - Street 2:SUITE 6
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50321-2387
Practice Address - Country:US
Practice Address - Phone:515-285-1694
Practice Address - Fax:515-285-1636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6670261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0007203Medicaid