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General NPI Number Information
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NPI Number | 1770515389
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Entity Type | Individual
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Provider Name | TIFFANY PRISCILLA GREEN D.M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 101 LUCKNEY STATION RD
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City | FLOWOOD
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State | MS
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Zip | 39232-8402
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Country | US
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Telephone | 601-992-8000
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Fax | 601-992-8262
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Provider Business Mailing Address
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Address Line | 101 LUCKNEY STATION RD
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City | FLOWOOD
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State | MS
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Zip | 39232-8402
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Country | US
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Telephone | 601-992-8000
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Fax | 601-992-8262
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | PEDO-399-06
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License Number State | MS
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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 | 3296-04
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License Number State | MS
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