Provider Demographics
NPI:1730396805
Name:GREENE, MATTHEW ROBERT (DENTIST)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:GREENE
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8600 LASALLE RD
Mailing Address - Street 2:SUITE 616
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-2001
Mailing Address - Country:US
Mailing Address - Phone:410-823-8600
Mailing Address - Fax:419-823-7005
Practice Address - Street 1:8600 LASALLE RD
Practice Address - Street 2:SUITE 616
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-2001
Practice Address - Country:US
Practice Address - Phone:410-823-8600
Practice Address - Fax:419-823-7005
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD66871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice