Healthcare Provider Details

I. General information

NPI: 1841223625
Provider Name (Legal Business Name): MYRIAM NANTES GREENE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 MAIN ST
WOLF POINT MT
59201-1530
US

IV. Provider business mailing address

116 MAIN ST
WOLF POINT MT
59201-1530
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-2890
  • Fax: 406-653-2891
Mailing address:
  • Phone: 406-653-2890
  • Fax: 406-653-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2182
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: