=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649357740
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OSCAR H GREENE JR. DMD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 06/19/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12 PARMENTER RD
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03083
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-432-7773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12 PARMENTER RD
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-3280
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-432-7773
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | OSCAR H GREENE JR.
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 603-432-7771
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 1519
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------