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General NPI Number Information
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NPI Number | 1659997658
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Entity Type | Individual
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Provider Name | SHEILA JO GREEN LHD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 113 N CHESTNUT ST STE 100
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City | SEYMOUR
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State | IN
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Zip | 47274-2190
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Country | US
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Telephone | 812-524-8388
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Fax | 812-954-5021
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Provider Business Mailing Address
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Address Line | 1510 NEW FORD RD
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City | SEYMOUR
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State | IN
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Zip | 47274-2263
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Country | US
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Telephone | 812-569-8640
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 13005538A
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License Number State | IN
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