Provider Demographics
NPI:1700835022
Name:GREENE, STEPHANIE WEST (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:WEST
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 1:4235 MUNDY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2517
Mailing Address - Country:US
Mailing Address - Phone:770-532-2003
Mailing Address - Fax:770-532-2241
Practice Address - Street 1:4235 MUNDY MILL RD
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2517
Practice Address - Country:US
Practice Address - Phone:770-532-2003
Practice Address - Fax:770-532-2241
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0122341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice