Provider Demographics
NPI:1225163124
Name:GREENE, BENJAMIN J (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:GREENE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17214 SE 29TH CT
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5650
Mailing Address - Country:US
Mailing Address - Phone:425-747-3363
Mailing Address - Fax:
Practice Address - Street 1:1715 MARKET ST STE 104
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-4968
Practice Address - Country:US
Practice Address - Phone:425-822-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist