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General NPI Number Information
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NPI Number | 1285669820
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Entity Type | Organization
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Legal Business Name | DR TOM GREEN & ASSOCIATES, PC
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Dates
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Enumeration Date | 07/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 W BEAU ST
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City | WASHINGTON
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State | PA
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Zip | 15301-4425
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Country | US
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Telephone | 724-223-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 150 W BEAU ST
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City | WASHINGTON
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State | PA
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Zip | 15301-4425
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Country | US
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Telephone | 724-223-0220
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TOM GREEN
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Credential | DMD
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Telephone | 724-223-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22007
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License Number State | PA
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