Provider Demographics
NPI:1851956163
Name:GREENE, KELSEY ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELIZABETH
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 1:212 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-3142
Mailing Address - Country:US
Mailing Address - Phone:434-238-4446
Mailing Address - Fax:
Practice Address - Street 1:20936 TIMBERLAKE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-7353
Practice Address - Country:US
Practice Address - Phone:434-237-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014164611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice