MEDICARE: DR. RENEE SHIRLEY GREENE DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	40926	TX

General Provider Information

NPI Number	:	1598340481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENEE SHIRLEY GREENE DDS

Provider Business Mailing Address
First Line	:	16601 SIMONNE LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-4354
Country	:	US
Telephone Number	:	714-469-6755
Fax Number	:

Provider Business Practice Location Address
First Line	:	1616 E 8TH ST
Second Line	:
City	:	ODESSA
State	:	TX
Zip	:	79761-4807
Country	:	US
Telephone Number	:	806-794-8124
Fax Number	:

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

Provider Enumeration Date	:	03/12/2021
Last Update Date	:	08/22/2024

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Directions to “ DR. RENEE SHIRLEY GREENE DDS” Practice Location

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