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NPI Code Detail

MEDICARE: JUSTIN A GREEN DMD

MEDICARE: JUSTIN A GREEN DMD
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
1122300000XDentist10759TN
21223G0001XGeneral Practice Dentistry12013955AIN

General Provider Information

NPI Number : 1750874210
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN A GREEN DMD
Provider Business Mailing Address
First Line : 8118 SYCAMORE CREEK DR
Second Line :
City : LOUISVILLE
State : KY
Zip : 40222-3937
Country : US
Telephone Number : 740-525-1125
Fax Number :
Provider Business Practice Location Address
First Line : 2241 STATE ST STE C
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-4949
Country : US
Telephone Number : 812-945-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2018
Last Update Date : 11/30/2022

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Directions to “ JUSTIN A GREEN DMD” Practice Location

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