Provider Demographics
NPI:1851436307
Name:GREER, JAMES RUSSELL (DMD, MS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:RUSSELL
Last Name:GREER
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1708
Mailing Address - Country:US
Mailing Address - Phone:502-857-0807
Mailing Address - Fax:
Practice Address - Street 1:1200 MASTER ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2502
Practice Address - Country:US
Practice Address - Phone:606-253-1961
Practice Address - Fax:606-523-1978
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48621223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics