Provider Demographics
NPI:1306035191
Name:GREENWOOD, JEFFRY JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFRY
Middle Name:JAMES
Last Name:GREENWOOD
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 1:3500 LOMITA BLVD
Mailing Address - Street 2:301
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5021
Mailing Address - Country:US
Mailing Address - Phone:310-530-4120
Mailing Address - Fax:310-257-8650
Practice Address - Street 1:3500 LOMITA BLVD
Practice Address - Street 2:301
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5021
Practice Address - Country:US
Practice Address - Phone:310-530-4120
Practice Address - Fax:310-257-8650
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA334641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice