Provider Demographics
NPI:1447342480
Name:GREENE, LYNN A (DDS)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:A
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 1:1234 CENTRAL PARK AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-1068
Mailing Address - Country:US
Mailing Address - Phone:914-771-5330
Mailing Address - Fax:
Practice Address - Street 1:1234 CENTRAL PARK AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1068
Practice Address - Country:US
Practice Address - Phone:914-771-5330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYT50079Medicare UPIN
NYD7E271Medicare UPIN