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General NPI Number Information
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NPI Number | 1437764180
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Entity Type | Organization
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Legal Business Name | JOHN O. GREEN, II, DDS, PC
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Dates
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Enumeration Date | 09/10/2020
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Last Update Date | 09/10/2020
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Provider Practice Location Address
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Address Line | 6126 PRESTLEY MILL RD STE J
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5624
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Country | US
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Telephone | 770-489-1450
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Fax |
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Provider Business Mailing Address
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Address Line | 6126 PRESTLEY MILL RD STE J
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-5624
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. JOHN O GREEN II
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Credential | DDS
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Telephone | 770-489-1450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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