Provider Demographics
NPI:1033200365
Name:GREENE, VERNON W (DMD)
Entity type:Individual
Prefix:DR
First Name:VERNON
Middle Name:W
Last Name:GREENE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1229 EAGLES LANDING PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-5114
Mailing Address - Country:US
Mailing Address - Phone:770-474-1431
Mailing Address - Fax:770-474-2353
Practice Address - Street 1:1229 EAGLES LANDING PKWY STE A
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-5114
Practice Address - Country:US
Practice Address - Phone:770-474-1431
Practice Address - Fax:770-474-2353
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008312122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist