Provider Demographics
NPI:1326248899
Name:GREENHILL, JEFFREY M (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:GREENHILL
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 1:12377 S CLEVELAND AVE
Mailing Address - Street 2:SUITE #17
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3899
Mailing Address - Country:US
Mailing Address - Phone:239-936-4757
Mailing Address - Fax:239-936-0791
Practice Address - Street 1:12377 S CLEVELAND AVE
Practice Address - Street 2:SUITE #17
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3899
Practice Address - Country:US
Practice Address - Phone:239-936-4757
Practice Address - Fax:239-936-0791
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN100581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice