Individual
JESSICA TANYA GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
32020 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9734
(360) 297-2840
Mailing address
32020 LITTLE BOSTON RD NE, KINGSTON, WA 98346-9734
Taxonomy
Speciality
Code
Description
License number
State
125J00000X
Dental Therapist
Primary
25-0001-DHAT
WA
Other
Enumeration date
09/04/2025
Last updated
09/04/2025
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