MEDICARE: NICHOLAS BERNARD GREENE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS045764	PA

General Provider Information

NPI Number	:	1073447231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BERNARD GREENE

Provider Business Mailing Address
First Line	:	927 CASTLEBERRY LN
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16601-8909
Country	:	US
Telephone Number	:	814-656-2503
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 UNION AVE
Second Line	:
City	:	ALTOONA
State	:	PA
Zip	:	16602-3270
Country	:	US
Telephone Number	:	814-942-1628
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2026
Last Update Date	:	06/11/2026

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Directions to “ NICHOLAS BERNARD GREENE ” Practice Location

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