Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN17165 | FL |
NPI | 1003062134 |
---|---|
Provider Name | Jamie Greear |
First Address | Pembroke Pines, FL 33024-4650 |
Second Address | Pembroke Pines, FL 33024-4650 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2008 |
Last Update Date | 11/08/2008 |