Provider Demographics
NPI:1548444680
Name:ROBERT O GREER JR DDS SCD
Entity type:Organization
Organization Name:ROBERT O GREER JR DDS SCD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:O
Authorized Official - Last Name:GREER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS SCD
Authorized Official - Phone:303-320-6827
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80038-0327
Mailing Address - Country:US
Mailing Address - Phone:303-657-2763
Mailing Address - Fax:303-657-9023
Practice Address - Street 1:180 ADAMS ST
Practice Address - Street 2:250
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-5223
Practice Address - Country:US
Practice Address - Phone:303-320-6827
Practice Address - Fax:303-320-0463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00722292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08678138Medicaid
COC67813Medicare PIN