Provider Demographics
NPI:1972024115
Name:KALLEB A. GREENE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:KALLEB A. GREENE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KALLEB
Authorized Official - Middle Name:ANDERSON
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-885-6137
Mailing Address - Street 1:542 NOEL AVE
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-1386
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY99891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty