Provider Demographics
NPI:1518236751
Name:JOSEPH R. GREENWOOD, DMD, PC
Entity Type:Organization
Organization Name:JOSEPH R. GREENWOOD, DMD, PC
Other - Org Name:CRESWELL FAMILY DENTAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:GREENWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-985-3608
Mailing Address - Street 1:56 ALMOND WAY
Mailing Address - Street 2:PO BOX 65
Mailing Address - City:CRESWELL
Mailing Address - State:OR
Mailing Address - Zip Code:97426-7911
Mailing Address - Country:US
Mailing Address - Phone:541-895-3608
Mailing Address - Fax:
Practice Address - Street 1:225 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9605
Practice Address - Country:US
Practice Address - Phone:541-895-4985
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD9645261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental