Provider Demographics
NPI:1265613400
Name:GREENE, SANDRA ALISON (RDH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ALISON
Last Name:GREENE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1491 CHASE LN
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3418
Mailing Address - Country:US
Mailing Address - Phone:210-391-8569
Mailing Address - Fax:
Practice Address - Street 1:120 S DENTON TAP RD
Practice Address - Street 2:SUITE 270-A
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-3297
Practice Address - Country:US
Practice Address - Phone:888-749-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14738124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist