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General NPI Number Information
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NPI Number | 1023510518
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Entity Type | Organization
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Legal Business Name | RALPH M. GREEN MEDICAL PLLC
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 3809 POPLAR LEVEL RD STE B
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City | LOUISVILLE
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State | KY
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Zip | 40213-1429
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Country | US
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Telephone | 502-459-4273
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Fax | 502-459-4343
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Provider Business Mailing Address
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Address Line | 3809 POPLAR LEVEL RD STE B
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City | LOUISVILLE
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State | KY
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Zip | 40213-1429
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Country | US
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Telephone | 502-459-4273
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Fax | 502-459-4343
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Authorized Official
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Title or Position | PROVIDER
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Name | LEWIS C. JONES
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Credential | DMD, MD
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Telephone | 502-459-4273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State | NULL
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