Provider Demographics
NPI:1164691622
Name:GREENE-MASKELL, KERI A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:A
Last Name:GREENE-MASKELL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KERI
Other - Middle Name:ALYSON
Other - Last Name:GREENE-MASKELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:380 N BROADWAY
Mailing Address - Street 2:SUITE L1
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-2115
Mailing Address - Country:US
Mailing Address - Phone:516-433-1422
Mailing Address - Fax:516-433-7007
Practice Address - Street 1:380 N BROADWAY
Practice Address - Street 2:SUITE L1
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-2115
Practice Address - Country:US
Practice Address - Phone:516-433-1422
Practice Address - Fax:516-433-7007
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047323-11223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics