Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 5905 | KY |
NPI | 1063510006 |
---|---|
Provider Name | Mrs. Earlene F Greene |
First Address | Danville, KY 40422-1804 |
Second Address | Danville, KY 40422 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 31/10/2019 |