Provider Demographics
NPI:1033205919
Name:GREENWOOD, WAYNE (DMD)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5905 W BELL RD
Mailing Address - Street 2:#6
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-3790
Mailing Address - Country:US
Mailing Address - Phone:602-547-9566
Mailing Address - Fax:602-547-1856
Practice Address - Street 1:5905 W BELL RD
Practice Address - Street 2:#6
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-3790
Practice Address - Country:US
Practice Address - Phone:602-547-9566
Practice Address - Fax:602-547-1856
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ56581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice