Healthcare Provider Details

I. General information

NPI: 1467788497
Provider Name (Legal Business Name): KIMBERLY MICHELLE GREEN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2009
Last Update Date: 03/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 5TH AVE N
BESSEMER AL
35020-4170
US

IV. Provider business mailing address

230 E 10TH ST SUITE 106
ANNISTON AL
36207-5784
US

V. Phone/Fax

Practice location:
  • Phone: 205-425-1327
  • Fax: 205-425-2864
Mailing address:
  • Phone: 256-741-7340
  • Fax: 256-741-7373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5722
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number5722
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: