Provider Demographics
NPI:1932645157
Name:KURT J GREENWAY DDS
Entity Type:Organization
Organization Name:KURT J GREENWAY DDS
Other - Org Name:GREENWAY DENTAL EXCELLENCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREENWAY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-786-0600
Mailing Address - Street 1:3679 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3940
Mailing Address - Country:US
Mailing Address - Phone:951-786-0600
Mailing Address - Fax:951-786-0700
Practice Address - Street 1:3679 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3940
Practice Address - Country:US
Practice Address - Phone:951-786-0600
Practice Address - Fax:951-786-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38535261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental