Provider Demographics
NPI:1841223625
Name:GREENE, MYRIAM NANTES (DDS)
Entity Type:Individual
Prefix:
First Name:MYRIAM
Middle Name:NANTES
Last Name:GREENE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1530
Mailing Address - Country:US
Mailing Address - Phone:406-653-2890
Mailing Address - Fax:406-653-2891
Practice Address - Street 1:116 MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1530
Practice Address - Country:US
Practice Address - Phone:406-653-2890
Practice Address - Fax:406-653-2891
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT21824OtherBLUE CROSS / BLUE SHIELD
MT0113526Medicaid
MT5512879OtherMONTANA CHIPS PROGRAM