MEDICARE: DR. MOSHE NOAM GREEN D.M.D.

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN015014	GA

General Provider Information

NPI Number	:	1083055792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOSHE NOAM GREEN D.M.D.

Provider Business Mailing Address
First Line	:	2450 LAWRENCEVILLE HWY
Second Line	:	100
City	:	DECATUR
State	:	GA
Zip	:	30033-3268
Country	:	US
Telephone Number	:	404-850-1515
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 LAWRENCEVILLE HWY
Second Line	:	100
City	:	DECATUR
State	:	GA
Zip	:	30033-3268
Country	:	US
Telephone Number	:	404-850-1515
Fax Number	:

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

Provider Enumeration Date	:	07/10/2013
Last Update Date	:	08/26/2016

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