Provider Demographics
NPI:1518092881
Name:GREENE, KATHRINE BARRETT (DMD)
Entity Type:Individual
Prefix:DR
First Name:KATHRINE
Middle Name:BARRETT
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 1:1081 DOVE RUN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502
Mailing Address - Country:US
Mailing Address - Phone:859-269-7135
Mailing Address - Fax:859-269-7135
Practice Address - Street 1:1081 DOVE RUN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502
Practice Address - Country:US
Practice Address - Phone:859-269-7135
Practice Address - Fax:859-269-7135
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6691122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6006917Medicaid