Provider Demographics
NPI:1780975763
Name:GREENE, ERIN WILLIAMS (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:WILLIAMS
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:PO BOX 360580
Mailing Address - Street 2:
Mailing Address - City:MONUMENT VALLEY
Mailing Address - State:UT
Mailing Address - Zip Code:84536-0580
Mailing Address - Country:US
Mailing Address - Phone:435-727-3004
Mailing Address - Fax:
Practice Address - Street 1:30 WEST MEDICAL DRIVE
Practice Address - Street 2:
Practice Address - City:MONUMENT VALLEY
Practice Address - State:UT
Practice Address - Zip Code:84536
Practice Address - Country:US
Practice Address - Phone:435-727-3004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8400016-9921122300000X
TX280251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist