MEDICARE: JAMES EVANS GREENE D.D.S.

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
1	122300000X	Dentist	30015854	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790802692
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES EVANS GREENE D.D.S.

Provider Business Mailing Address
First Line	:	11900 SHAKER BLVD.
Second Line	:	2ND FLOOR
City	:	CLEVELAND
State	:	OH
Zip	:	44120
Country	:	US
Telephone Number	:	216-721-0500
Fax Number	:	216-721-0523

Provider Business Practice Location Address
First Line	:	11900 SHAKER BLVD
Second Line	:	2ND FLOOR
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1925
Country	:	US
Telephone Number	:	216-721-0500
Fax Number	:	216-721-0523

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2007
Last Update Date	:	08/25/2016

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