Provider Demographics
NPI:1083276224
Name:GREENE, ZACHARY KYLE (DDM)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:KYLE
Last Name:GREENE
Suffix:
Gender:M
Credentials:DDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 DORIC AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2903
Mailing Address - Country:US
Mailing Address - Phone:401-467-9610
Mailing Address - Fax:401-467-9030
Practice Address - Street 1:1090 CRANSTON ST
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-7323
Practice Address - Country:US
Practice Address - Phone:401-942-4867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN034661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty