Provider Demographics
NPI:1174675482
Name:GREER, TIMOTHY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:M
Last Name:GREER
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 1:724 KEMP CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8121
Mailing Address - Country:US
Mailing Address - Phone:317-496-5088
Mailing Address - Fax:
Practice Address - Street 1:7517 BEECHWOOD CENTRE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7852
Practice Address - Country:US
Practice Address - Phone:317-272-8100
Practice Address - Fax:317-272-0276
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010737A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice