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General NPI Number Information
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NPI Number | 1164241402
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Entity Type | Organization
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Legal Business Name | DORY GREEN DMD PA
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 646 N FEDERAL HWY
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-4686
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Country | US
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Telephone | 954-524-2300
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Fax | 954-342-6404
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Provider Business Mailing Address
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Address Line | 1313 S ANDREWS AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1837
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Country | US
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Telephone | 954-522-8554
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Fax | 954-522-8555
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Authorized Official
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Title or Position | OWNER
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Name | DR. DORY GREEN
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Credential | DMD, FAGD
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Telephone | 954-232-3866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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