Individual
JACOB GREAVES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
7101 PROSPECT PL NE, ALBUQUERQUE, NM 87110-4313
(505) 407-8781
Mailing address
7101 PROSPECT PL NE, ALBUQUERQUE, NM 87110-4313
(505) 407-8781
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DD4948
NM
Other
Enumeration date
07/06/2018
Last updated
07/06/2018
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