Healthcare Provider Details

I. General information

NPI: 1245629518
Provider Name (Legal Business Name): COLLEEN GREENE DMD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COLLEEN COLLINS

II. Dates (important events)

Enumeration Date: 01/09/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 W WISCONSIN AVE DENTAL CENTER
MILWAUKEE WI
53226-4874
US

IV. Provider business mailing address

7900 HARWOOD AVE APT. 111
MILWAUKEE WI
53213-2554
US

V. Phone/Fax

Practice location:
  • Phone: 414-266-2040
  • Fax: 414-266-5677
Mailing address:
  • Phone: 810-394-6539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7288-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: