Provider Demographics
NPI:1699856591
Name:GREER, CHARLES E (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
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 1:6046 U S HIGHWAY 49
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7366
Mailing Address - Country:US
Mailing Address - Phone:601-582-1143
Mailing Address - Fax:601-583-1657
Practice Address - Street 1:6046 U S HIGHWAY 49
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7366
Practice Address - Country:US
Practice Address - Phone:601-582-1143
Practice Address - Fax:601-583-1657
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1390-701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00064055Medicaid