Provider Demographics
NPI:1841080447
Name:GREENAN, GERALD (DMD)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:
Last Name:GREENAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF DETROIT MERCY
Mailing Address - Street 2:2700 MARTIN LUTHER KING JR BLVD
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208
Mailing Address - Country:US
Mailing Address - Phone:313-494-6873
Mailing Address - Fax:313-494-6834
Practice Address - Street 1:UNIVERSITY OF DETROIT MERCY
Practice Address - Street 2:2700 MARTIN LUTHER KING JR BLVD
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208
Practice Address - Country:US
Practice Address - Phone:313-494-6873
Practice Address - Fax:313-494-6834
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-08
Last Update Date:2025-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI2951000995390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program