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General NPI Number Information
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NPI Number | 1497065551
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Entity Type | Individual
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Provider Name | JOHN ARMSTRONG GREEN DMD
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Gender | Male
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Dates
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Enumeration Date | 10/07/2010
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Last Update Date | 02/04/2019
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Provider Practice Location Address
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Address Line | 5029 S 1200 E
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City | OGDEN
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State | UT
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Zip | 84403-4297
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Country | US
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Telephone | 801-648-3653
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Fax |
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Provider Business Mailing Address
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Address Line | 5029 S 1200 E
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City | OGDEN
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State | UT
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Zip | 84403-4297
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Country | US
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Telephone | 801-648-3653
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE60434325
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7692415-9922
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License Number State | UT
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D10029
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License Number State | OR
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