Provider Demographics
NPI:1922524503
Name:GREENE, KALLEB ANDERSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:KALLEB
Middle Name:ANDERSON
Last Name:GREENE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 COOL WATER CT STE A
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-8781
Mailing Address - Country:US
Mailing Address - Phone:270-885-6137
Mailing Address - Fax:
Practice Address - Street 1:318 COOL WATER CT STE A
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-8781
Practice Address - Country:US
Practice Address - Phone:270-885-6137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice