Individual
DR. JESSE N GREAVES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
1401 E 3900 S, SUITE 102, SALT LAKE CITY, UT 84124-1475
(801) 272-8051
(801) 272-9109
Mailing address
1401 E 3900 S, SUITE 102, SALT LAKE CITY, UT 84124-1475
(801) 272-8051
(801) 272-9109
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
277806
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000838204
BCBS OF KS PROVIDER
KS
01
—
1320390
UNITED CONCORDIA PROVIDER
—
01
—
314279
DMBA PROVIDER
UT
01
—
46060
PEHP PROVIDER
—
01
—
870570767HR1
EDUCATORS MUTUAL
UT
Enumeration date
08/17/2006
Last updated
07/08/2007
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