1245629518 NPI number — DR. COLLEEN GREENE DMD, MPH

Table of content: DR. COLLEEN GREENE DMD, MPH (NPI 1245629518)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245629518 NPI number — DR. COLLEEN GREENE DMD, MPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENE
Provider First Name:
COLLEEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD, MPH
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLLINS
Provider Other First Name:
COLLEEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1245629518
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7900 HARWOOD AVE
Provider Second Line Business Mailing Address:
APT. 111
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53213-2554
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
810-394-6539
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9000 W WISCONSIN AVE
Provider Second Line Business Practice Location Address:
DENTAL CENTER
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53226-4874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-266-2040
Provider Business Practice Location Address Fax Number:
414-266-5677
Provider Enumeration Date:
01/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  7288-15 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1245629518 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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