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General NPI Number Information
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NPI Number | 1700809654
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Entity Type | Individual
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Provider Name | WILLIAM ALLEN GREEN DMD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 05/28/2010
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Provider Practice Location Address
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Address Line | 44 MAIN ST RICHFORD DENTAL CLINIC
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City | RICHFORD
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State | VT
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Zip | 05476-1153
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Country | US
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Telephone | 802-255-5563
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Fax | 802-255-5569
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Provider Business Mailing Address
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Address Line | 810 MAQUAM SHORE RD
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City | SWANTON
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State | VT
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Zip | 05488-8416
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Country | US
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Telephone | 802-524-0930
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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 | 0160064702
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License Number State | VT
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