Provider Demographics
NPI:1679677785
Name:GREELEY, DONALD JAMES (DMD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JAMES
Last Name:GREELEY
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 1:53 COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4827
Mailing Address - Country:US
Mailing Address - Phone:781-749-3645
Mailing Address - Fax:781-749-3645
Practice Address - Street 1:4 RICHMOND ST
Practice Address - Street 2:
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02188-2519
Practice Address - Country:US
Practice Address - Phone:781-337-0406
Practice Address - Fax:781-335-3566
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA91551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA08419390OtherEMPLOYER ID
MA40107OtherHARVARD PILGRIM
MA0215856Medicaid
MAX04077OtherBLUE CROSS BLUE SHIELD