MEDICARE: DR. WILLIAM PHILLIP GREEN DDS

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	122300000X	Dentist	7340	TN

General Provider Information

NPI Number	:	1174512479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM PHILLIP GREEN DDS

Provider Business Mailing Address
First Line	:	1411 HONEYSUCKLE LN
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37040-4752
Country	:	US
Telephone Number	:	931-920-3232
Fax Number	:	931-551-9520

Provider Business Practice Location Address
First Line	:	1573 FORT CAMPBELL BLVD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-3535
Country	:	US
Telephone Number	:	931-553-0919
Fax Number	:	931-553-0971

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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