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General NPI Number Information
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NPI Number | 1952494858
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Entity Type | Individual
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Provider Name | SHELBY MARIE GREEN DDS
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 03/03/2010
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Provider Practice Location Address
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Address Line | 6102 82ND ST SUITE 1
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City | LUBBOCK
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State | TX
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Zip | 79424-0802
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Country | US
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Telephone | 806-799-8160
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Fax | 806-799-7826
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Provider Business Mailing Address
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Address Line | 6102 82ND ST. SUITE 1
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City | LUBBOCK
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State | TX
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Zip | 79424
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Country | UM
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Telephone | 806-799-8160
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Fax | 806-799-7826
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 17635
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License Number State | TX
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