Individual
HARRY MARK GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1196 PINE GROVE RD, TALLAPOOSA, GA 30176
(770) 574-2812
(770) 574-5020
Mailing address
PO BOX 386, TALLAPOOSA, GA 30176
(770) 574-2812
(770) 574-5020
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
8271
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00046241A
—
GA
Enumeration date
03/05/2007
Last updated
07/08/2007
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