Provider Demographics
NPI:1891898201
Name:GREENWOOD, JOHN P (DDS)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:P
Last Name:GREENWOOD
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 1:276 W 9TH STREET
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5949
Mailing Address - Country:US
Mailing Address - Phone:909-985-1996
Mailing Address - Fax:909-985-1256
Practice Address - Street 1:276 W 9TH STREET
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5949
Practice Address - Country:US
Practice Address - Phone:909-985-1996
Practice Address - Fax:909-985-1256
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA309591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice