Provider Demographics
NPI:1669964581
Name:GREENE, LISA A (RDH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
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:CONSERVATIVE DENTAL SOLUTIONS
Mailing Address - Street 2:101 N CROSS STREET
Mailing Address - City:WAVELAND
Mailing Address - State:IN
Mailing Address - Zip Code:47989
Mailing Address - Country:US
Mailing Address - Phone:765-435-2380
Mailing Address - Fax:765-435-2382
Practice Address - Street 1:CONSERVATIVE DENTAL SOLUTIONS
Practice Address - Street 2:101 N CROSS STREET
Practice Address - City:WAVELAND
Practice Address - State:IN
Practice Address - Zip Code:47989
Practice Address - Country:US
Practice Address - Phone:765-435-2380
Practice Address - Fax:765-435-2382
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN13002837A124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist