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General NPI Number Information
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NPI Number | 1922110444
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Entity Type | Organization
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Legal Business Name | STEPHEN I GREEN DDS PA
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7501 GREENWAY CENTER DRIVE #268
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City | GREENBELT
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State | MD
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Zip | 20770
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Country | US
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Telephone | 301-345-1222
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Fax | 301-345-8945
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Provider Business Mailing Address
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Address Line | 7501 GREENWAY CENTER DRIVE #268
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City | GREENBELT
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State | MD
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Zip | 20770
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Country | US
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Telephone | 301-345-1222
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Fax | 301-345-8945
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Authorized Official
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Title or Position | PRES
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Name | STEPHEN I GREEN
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Credential | DDS
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Telephone | 301-345-1222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 4562
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License Number State | MD
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