Provider Demographics
NPI:1215063342
Name:GREENLEY, JENNIFER REBECCA (DDS)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:REBECCA
Last Name:GREENLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 ARONIMINK DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-3833
Mailing Address - Country:US
Mailing Address - Phone:302-737-2245
Mailing Address - Fax:
Practice Address - Street 1:702 E BASIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4263
Practice Address - Country:US
Practice Address - Phone:302-322-0245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-25
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG3-00003321223G0001X
DEG1-00012371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice