Provider Demographics
NPI:1801887633
Name:GREENE, IRA M (DDS)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:M
Last Name:GREENE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10 SACHEMS TRL
Mailing Address - Street 2:
Mailing Address - City:WEST SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06092-2525
Mailing Address - Country:US
Mailing Address - Phone:860-651-8428
Mailing Address - Fax:
Practice Address - Street 1:34 DALE RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3659
Practice Address - Country:US
Practice Address - Phone:330-674-0874
Practice Address - Fax:860-674-8716
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT5835CT1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry