Healthcare Provider Details

I. General information

NPI: 1902738040
Provider Name (Legal Business Name): HOLLY GREEN, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVE STE 225
ANNAPOLIS MD
21401-1089
US

IV. Provider business mailing address

600 RIDGELY AVE STE 225
ANNAPOLIS MD
21401-1089
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-9608
  • Fax: 410-224-9650
Mailing address:
  • Phone: 410-224-9608
  • Fax: 410-224-9650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. HOLLY GREEN
Title or Position: OWNER/DENTIST
Credential: DMD
Phone: 410-224-9608