Provider Demographics
NPI:1780866996
Name:JEFFREY GREENHILL, D.D.S.PA
Entity Type:Organization
Organization Name:JEFFREY GREENHILL, D.D.S.PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:239-936-4757
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:239-936-0971
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:239-936-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN100581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty