MEDICARE: DR. NATHAN SOSAIA GREEN DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D-00188	KY

General Provider Information

NPI Number	:	1043140403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN SOSAIA GREEN DMD

Provider Business Mailing Address
First Line	:	2205 OLMSTEAD CT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1804
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 BEAUMONT CENTRE CIR STE 114
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40513-1836
Country	:	US
Telephone Number	:	859-223-0011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2026
Last Update Date	:	05/19/2026

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