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General NPI Number Information
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NPI Number | 1821262601
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Entity Type | Organization
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Legal Business Name | GREEN ORTHODONTICS PLLC
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Dates
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Enumeration Date | 04/14/2008
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 2287 RALEIGH COURT STE C
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City | CLARKSVILLE
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State | TN
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Zip | 37043
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Country | US
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Telephone | 931-542-9940
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Fax |
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Provider Business Mailing Address
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Address Line | 2287 RALEIGH COURT STE C
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City | CLARKSVILLE
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State | TN
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Zip | 37043
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Country | US
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Telephone | 931-542-9940
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Fax |
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Authorized Official
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Title or Position | SENIOR CREDENTIALING TEAM LEAD
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Name | JENNY GARCIA-ROCHA
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Credential |
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Telephone | 972-869-3789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 8151
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License Number State | TN
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