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General NPI Number Information
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NPI Number | 1073447231
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Entity Type | Individual
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Provider Name | NICHOLAS BERNARD GREENE
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Gender | Male
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/11/2026
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Provider Practice Location Address
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Address Line | 200 UNION AVE
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City | ALTOONA
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State | PA
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Zip | 16602-3270
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Country | US
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Telephone | 814-942-1628
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Fax |
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Provider Business Mailing Address
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Address Line | 927 CASTLEBERRY LN
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City | ALTOONA
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State | PA
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Zip | 16601-8909
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Country | US
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Telephone | 814-656-2503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS045764
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License Number State | PA
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