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General NPI Number Information
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NPI Number | 1306663059
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Entity Type | Organization
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Legal Business Name | GREENE DENTAL MANAGEMENT, PLLC
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Dates
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Enumeration Date | 09/24/2024
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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 | 32114-6151
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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 | 1021 S RIDGEWOOD AVE
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-6151
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Country | US
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Telephone | 386-304-2677
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEPHEN GREENE
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Credential |
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Telephone | 850-251-1643
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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