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General NPI Number Information
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NPI Number | 1134678006
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Entity Type | Organization
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Legal Business Name | MICHAEL L GREEN, DDS, INC
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Dates
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Enumeration Date | 10/03/2016
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Last Update Date | 10/03/2016
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Provider Practice Location Address
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Address Line | 2821 EASTERN AVE STE 5
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City | SACRAMENTO
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State | CA
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Zip | 95821-5445
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Country | US
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Telephone | 916-483-7354
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Fax | 916-483-1390
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Provider Business Mailing Address
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Address Line | 2821 EASTERN AVE STE 5
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City | SACRAMENTO
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State | CA
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Zip | 95821-5445
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Country | US
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Telephone | 916-483-7354
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Fax | 916-483-1390
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | MICHAEL L GREEN
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Credential | DDS
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Telephone | 916-483-7354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 34706
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License Number State | CA
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