Provider Demographics
NPI:1891999694
Name:GREENE, TREVOR STANLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:STANLEY
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 1:8743 PINEY ORCHARD PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-2343
Mailing Address - Country:US
Mailing Address - Phone:443-406-6884
Mailing Address - Fax:
Practice Address - Street 1:8743 PINEY ORCHARD PKWY
Practice Address - Street 2:SUITE 111
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-2343
Practice Address - Country:US
Practice Address - Phone:443-406-6884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD141011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice