Provider Demographics
NPI:1235193772
Name:GREENE, PATRICIA MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MARIE
Last Name:GREENE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6929 N HAYDEN RD. #C4-173
Mailing Address - Street 2:SUITE C4-173
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-7978
Mailing Address - Country:US
Mailing Address - Phone:602-525-6893
Mailing Address - Fax:
Practice Address - Street 1:3311 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7302
Practice Address - Country:US
Practice Address - Phone:602-525-6893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD47751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391912Medicaid