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General NPI Number Information
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NPI Number | 1558314385
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Entity Type | Individual
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Provider Name | JOEL D GREEN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 02/15/2013
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Provider Practice Location Address
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Address Line | 950 W COY SMITH HWY
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City | MOUNT VERNON
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State | AL
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Zip | 36560-3201
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Country | US
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Telephone | 251-829-9884
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Fax | 251-829-9507
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Provider Business Mailing Address
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Address Line | 251 N BAYOU ST
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City | MOBILE
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State | AL
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Zip | 36603-5827
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Country | US
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Telephone | 251-690-8158
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Fax | 251-544-2188
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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 | ETD0008
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License Number State | AL
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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 | 5458C
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License Number State | AL
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