Provider Demographics
NPI:1972538163
Name:GREENE CO DENTAL CLINIC
Entity Type:Organization
Organization Name:GREENE CO DENTAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY COUNTY ADMINISTRATOR FINANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-985-5201
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:40 CELT RD
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973
Mailing Address - Country:US
Mailing Address - Phone:434-985-5217
Mailing Address - Fax:434-985-1390
Practice Address - Street 1:40 CELT ROAD
Practice Address - Street 2:COUNTY OFFICE BUILDING
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973
Practice Address - Country:US
Practice Address - Phone:434-985-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401005184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty