Provider Demographics
NPI:1639998784
Name:GREENE, STAR (RDH)
Entity type:Individual
Prefix:
First Name:STAR
Middle Name:
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 1:1420 E G ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-6231
Mailing Address - Country:US
Mailing Address - Phone:402-326-9536
Mailing Address - Fax:
Practice Address - Street 1:1225 S POPLAR ST STE 500
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6298
Practice Address - Country:US
Practice Address - Phone:308-534-8080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3100124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist