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General NPI Number Information
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NPI Number | 1477988525
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Entity Type | Organization
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Legal Business Name | DAVID GREEN DDS PA
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Dates
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Enumeration Date | 09/09/2013
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Last Update Date | 08/02/2016
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Provider Practice Location Address
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Address Line | 11135 S JOG RD SUITE 3
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-1807
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Country | US
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Telephone | 561-733-3361
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Fax | 561-733-8865
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Provider Business Mailing Address
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Address Line | 11135 S JOG RD SUITE 3
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City | BOYNTON BEACH
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State | FL
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Zip | 33437-1807
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Country | US
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Telephone | 561-733-3361
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Fax | 561-733-8865
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Authorized Official
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Title or Position | ADM. ASSIST
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Name | LYNDA CAUWELS
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Credential |
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Telephone | 561-733-3361
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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 | 15023
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License Number State | FL
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