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General NPI Number Information
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NPI Number | 1588783344
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Entity Type | Individual
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Provider Name | AMANDA S. GREEN DMD
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Gender | Female
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 01/31/2024
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Provider Practice Location Address
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Address Line | 763 E. MAIN STREET
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City | SPARTANBURG
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State | SC
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Zip | 29302
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Country | US
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Telephone | 864-585-8558
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Fax | 864-580-4242
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Provider Business Mailing Address
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Address Line | 763 E. MAIN STREET
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City | SPARTANBURG
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State | SC
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Zip | 29302
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Country | US
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Telephone | 864-585-8558
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Fax | 864-580-4242
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | SC 3703
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 738PD
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License Number State | SC
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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 | 3703
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License Number State | SC
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