Provider Demographics
NPI:1669531745
Name:GREYSTONE ORTHODONTICS INC
Entity type:Organization
Organization Name:GREYSTONE ORTHODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JANA
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-408-0894
Mailing Address - Street 1:5510 HIGHWAY 280
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-6579
Mailing Address - Country:US
Mailing Address - Phone:205-408-0894
Mailing Address - Fax:205-408-0871
Practice Address - Street 1:5510 HIGHWAY 280
Practice Address - Street 2:SUITE 201
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6579
Practice Address - Country:US
Practice Address - Phone:205-408-0894
Practice Address - Fax:205-408-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty