Provider Demographics
NPI:1457491813
Name:GREENE, STEVEN C (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:GREENE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:972 ROUTE 45
Mailing Address - Street 2:STE 102
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3519
Mailing Address - Country:US
Mailing Address - Phone:845-354-6634
Mailing Address - Fax:845-354-6901
Practice Address - Street 1:972 ROUTE 45
Practice Address - Street 2:STE 102
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3519
Practice Address - Country:US
Practice Address - Phone:845-354-6634
Practice Address - Fax:845-354-6901
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0303701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY136731459OtherEMPLOYER ID