Provider Demographics
NPI:1053920629
Name:CHRISTINA GREENE FAMILY DENTISTRY
Entity type:Organization
Organization Name:CHRISTINA GREENE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-218-0248
Mailing Address - Street 1:1050 OASIS CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6337
Mailing Address - Country:US
Mailing Address - Phone:214-218-0248
Mailing Address - Fax:
Practice Address - Street 1:5336 N TARRANT PKWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-6293
Practice Address - Country:US
Practice Address - Phone:817-656-9078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental