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General NPI Number Information
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NPI Number | 1245844851
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Entity Type | Organization
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Legal Business Name | GREEN DENTISTRY, LLC
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 8611 2ND AVE STE 201
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City | SILVER SPRING
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State | MD
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Zip | 20910-6349
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Country | US
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Telephone | 301-359-1188
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Fax |
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Provider Business Mailing Address
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Address Line | 7903 ORION CIR UNIT 359
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City | LAUREL
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State | MD
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Zip | 20724-3112
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Country | US
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Telephone | 305-713-7796
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Fax |
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Authorized Official
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Title or Position | MANAGER/CLINICIAN
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Name | DR. KRISTEN MILLENDER
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Credential | DDS
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Telephone | 305-713-7796
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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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