Healthcare Provider Details

I. General information

NPI: 1033030713
Provider Name (Legal Business Name): GREEN FAMILY DENTAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2926 PROFESSIONAL PKWY
AUGUSTA GA
30907-6530
US

IV. Provider business mailing address

2926 PROFESSIONAL PKWY
AUGUSTA GA
30907-6530
US

V. Phone/Fax

Practice location:
  • Phone: 706-860-0575
  • Fax:
Mailing address:
  • Phone: 706-860-0575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTEN GREEN
Title or Position: OWNER, DENTIST
Credential: DMD
Phone: 706-860-0575