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NPI Code Detail

MEDICARE: ERIN GREEN DDS PC

MEDICARE: ERIN GREEN DDS PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11699113365OTHERMSNPI
21669810040OTHERLANPI

General Provider Information

NPI Number : 1609492750
Entity Type Code : Organization
Provider Name (Legal Business Name) : ERIN GREEN DDS PC
Provider Business Mailing Address
First Line : 1075 LAKE VILLAGE CIR
Second Line :
City : BRANDON
State : MS
Zip : 39047-6743
Country : US
Telephone Number : 601-850-2145
Fax Number :
Provider Business Practice Location Address
First Line : 1075 LAKE VILLAGE CIR
Second Line :
City : BRANDON
State : MS
Zip : 39047-6743
Country : US
Telephone Number : 601-992-1605
Fax Number :
Authorized Official
Title or Position : OWNER
Name : DR. ERIN GREEN
Credential : DDS
Telephone Number : 601-850-2145
Provider Enumeration Date : 06/24/2020
Last Update Date : 06/24/2020

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Directions to “ERIN GREEN DDS PC ” Practice Location

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