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Individual
DR. BOLEY JACOB GREENWOOD
Active
Individual
DR. BOLEY JACOB GREENWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
6215313-9922
UT
1223P0221X
Pediatric Dentistry
Primary
30-023398
OH
Other
Enumeration date
11/01/2006
Last updated
08/18/2011
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