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Individual
JON C GREENE
Active
Individual
JON C GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
24012
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24012
STATE BOARD OF DENTAL EXAMINERS
TX
Enumeration date
09/16/2008
Last updated
08/12/2014
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