MEDICARE: DR. TREVOR STANLEY 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	1223G0001X	General Practice Dentistry	14101	MD

General Provider Information

NPI Number	:	1891999694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TREVOR STANLEY GREENE DDS

Provider Business Mailing Address
First Line	:	8743 PINEY ORCHARD PKWY STE 111
Second Line	:
City	:	ODENTON
State	:	MD
Zip	:	21113-2343
Country	:	US
Telephone Number	:	443-406-6884
Fax Number	:

Provider Business Practice Location Address
First Line	:	8743 PINEY ORCHARD PKWY
Second Line	:	SUITE 111
City	:	ODENTON
State	:	MD
Zip	:	21113-2343
Country	:	US
Telephone Number	:	443-406-6884
Fax Number	:

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	02/06/2023

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