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General NPI Number Information
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NPI Number | 1194113373
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Entity Type | Individual
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Provider Name | STEPHEN LAMAR GREENE D.D.S
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Gender | Male
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Dates
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Enumeration Date | 12/22/2014
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 1021 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6114
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Country | US
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Telephone | 386-304-2677
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Fax |
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Provider Business Mailing Address
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Address Line | 2348 RIVERDALE CT
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City | OVIEDO
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State | FL
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Zip | 32765-8641
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Country | US
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Telephone | 850-251-1643
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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 | 6160
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 6160
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DN24580
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 24580
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License Number State | FL
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