Provider Demographics
NPI:1912375866
Name:GREENE, JANELLE PATRICIA (DDS)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:PATRICIA
Last Name:GREENE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1666 GLEN OAK CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-2256
Mailing Address - Country:US
Mailing Address - Phone:510-418-2007
Mailing Address - Fax:
Practice Address - Street 1:4515 HARDING PIKE STE 312
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37205-2197
Practice Address - Country:US
Practice Address - Phone:615-292-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-09
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650441223G0001X
TN112471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice