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General NPI Number Information
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NPI Number | 1467578344
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Entity Type | Organization
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Legal Business Name | STEVEN M GREEN D D S P C
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 10/20/2021
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Provider Practice Location Address
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Address Line | 4745 STATESMEN DR STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-5649
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Country | US
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Telephone | 317-482-7900
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Fax | 317-792-8588
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Provider Business Mailing Address
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Address Line | 4745 STATESMEN DR STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-5649
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Country | US
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Telephone | 317-482-7900
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Fax | 317-792-8588
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN MICHAEL GREEN
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Credential | DDS
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Telephone | 317-482-7900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 8575
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License Number State | IN
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