Healthcare Provider Details

I. General information

NPI: 1043140403
Provider Name (Legal Business Name): NATHAN SOSAIA GREEN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 BEAUMONT CENTRE CIR STE 114
LEXINGTON KY
40513-1836
US

IV. Provider business mailing address

2205 OLMSTEAD CT
LEXINGTON KY
40513-1804
US

V. Phone/Fax

Practice location:
  • Phone: 859-223-0011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD-00188
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: