Provider Demographics
NPI:1568512507
Name:GREENE, ERICA LORRAINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:LORRAINE
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:PO BOX 70907
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-0907
Mailing Address - Country:US
Mailing Address - Phone:229-883-3071
Mailing Address - Fax:229-883-5184
Practice Address - Street 1:1505 W 3RD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3647
Practice Address - Country:US
Practice Address - Phone:229-883-3071
Practice Address - Fax:229-883-5184
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0133041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice