Provider Demographics
NPI:1821105388
Name:GREENE, THOMAS R
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:GREENE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W HIGHWAY 290
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-3822
Mailing Address - Country:US
Mailing Address - Phone:512-661-0188
Mailing Address - Fax:512-661-0189
Practice Address - Street 1:711 W HIGHWAY 290
Practice Address - Street 2:
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-3822
Practice Address - Country:US
Practice Address - Phone:512-661-0188
Practice Address - Fax:512-661-0189
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46474122300000X
TX336591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist