Provider Demographics
NPI:1427702505
Name:GREENE, BRIA MORNIQUE
Entity type:Individual
Prefix:
First Name:BRIA
Middle Name:MORNIQUE
Last Name:GREENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 CRESTBROOK CT
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-1487
Mailing Address - Country:US
Mailing Address - Phone:336-327-0996
Mailing Address - Fax:
Practice Address - Street 1:510 NICHOLAS RD STE F
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27409-3404
Practice Address - Country:US
Practice Address - Phone:336-387-9168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice