Provider Demographics
NPI:1912375866
Name:GREENE, JANELLE PATRICIA (DDS)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:PATRICIA
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 1:154 MALLORCA WAY
Mailing Address - Street 2:APT 5
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-2188
Mailing Address - Country:US
Mailing Address - Phone:510-418-2007
Mailing Address - Fax:
Practice Address - Street 1:2480 MISSION ST
Practice Address - Street 2:SUITE 323-324
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-2468
Practice Address - Country:US
Practice Address - Phone:510-418-2007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice