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NPI Code Detail

MEDICARE: DR. CHARLES S GREENE DDS

MEDICARE: DR. CHARLES S GREENE DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry190-12322IL

General Provider Information

NPI Number : 1720193949
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES S GREENE DDS
Provider Business Mailing Address
First Line : 1041 RIDGE RD
Second Line : APT. 304
City : WILMETTE
State : IL
Zip : 60091-1560
Country : US
Telephone Number : 847-256-3999
Fax Number :
Provider Business Practice Location Address
First Line : 811 W WELLINGTON AVE
Second Line : DEPT OF DENTISTRY - AIMMC
City : CHICAGO
State : IL
Zip : 60657-5123
Country : US
Telephone Number : 773-871-4964
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2006
Last Update Date : 05/27/2009

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