Provider Demographics
NPI:1790802692
Name:GREENE, JAMES EVANS (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EVANS
Last Name:GREENE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 SHAKER BLVD.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120
Mailing Address - Country:US
Mailing Address - Phone:216-721-0500
Mailing Address - Fax:216-721-0523
Practice Address - Street 1:11900 SHAKER BLVD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1925
Practice Address - Country:US
Practice Address - Phone:216-721-0500
Practice Address - Fax:216-721-0523
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3408566Medicaid