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General NPI Number Information
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NPI Number | 1518551704
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Entity Type | Individual
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Provider Name | ANNA C GREEN D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 02/27/2021
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Last Update Date | 08/24/2023
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Provider Practice Location Address
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Address Line | 7505 W. DEER VALLEY RD SUITE 110
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-572-5777
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Fax | 623-572-7288
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Provider Business Mailing Address
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Address Line | 7505 W. DEER VALLEY RD SUITE 110
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City | PEORIA
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State | AZ
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Zip | 85382
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Country | US
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Telephone | 623-572-5777
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Fax | 623-572-7288
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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 | G1-0011548
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D011712
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License Number State | AZ
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