Provider Demographics
NPI:1841576147
Name:GREENWOOD, JOSEPH R (DMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:R
Last Name:GREENWOOD
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 1:1 JEFFERSON PKWY
Mailing Address - Street 2:APT# 177
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8847
Mailing Address - Country:US
Mailing Address - Phone:503-675-5024
Mailing Address - Fax:
Practice Address - Street 1:225 W OREGON AVE
Practice Address - Street 2:
Practice Address - City:CRESWELL
Practice Address - State:OR
Practice Address - Zip Code:97426-9605
Practice Address - Country:US
Practice Address - Phone:541-895-4985
Practice Address - Fax:541-895-2529
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice