Provider Demographics
NPI:1518115716
Name:GREENE, WILLIAM S (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
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 1:200 W CARVER ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3303
Mailing Address - Country:US
Mailing Address - Phone:631-673-4710
Mailing Address - Fax:631-673-3230
Practice Address - Street 1:200 W CARVER ST
Practice Address - Street 2:SUITE 6
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3303
Practice Address - Country:US
Practice Address - Phone:631-673-4710
Practice Address - Fax:631-673-3230
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0335081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics