Provider Demographics
NPI:1477566867
Name:GREENE, DAVID KEITH JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:KEITH
Last Name:GREENE
Suffix:JR
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 1:318 COOL WATER CT STE B
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1975
Mailing Address - Country:US
Mailing Address - Phone:270-885-5724
Mailing Address - Fax:270-885-3354
Practice Address - Street 1:318 COOL WATER CT STE B
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1975
Practice Address - Country:US
Practice Address - Phone:270-885-5724
Practice Address - Fax:270-885-3354
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 62181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY6218OtherKENTUCKY DENTAL LICENSE
KYKY6218OtherKENTUCKY DENTAL LICENSE
KY$$$$$$$$$OtherSOCIAL SECURITY NUMBER