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General NPI Number Information
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NPI Number | 1164626883
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Entity Type | Individual
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Provider Name | KEIRA VALE GREENE DDS
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Gender | Female
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 09/30/2020
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Provider Practice Location Address
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Address Line | 8636 N WAYNE DR
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City | HAYDEN
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State | ID
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Zip | 83835-5084
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Country | US
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Telephone | 303-810-9296
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Fax |
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Provider Business Mailing Address
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Address Line | 9323 N GOVERNMENT WAY STE 44
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City | HAYDEN
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State | ID
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Zip | 83835-8256
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Country | US
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Telephone | 303-810-9296
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | D-4879
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License Number State | ID
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