MEDICARE: DR. JEFFREY D. GREEN D.D.S.

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	DE00005705	WA

General Provider Information

NPI Number	:	1285639153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY D. GREEN D.D.S.

Provider Business Mailing Address
First Line	:	7011 51ST AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-6131
Country	:	US
Telephone Number	:	206-523-2947
Fax Number	:

Provider Business Practice Location Address
First Line	:	9730 3RD AVE NE
Second Line	:	STE 103
City	:	SEATTLE
State	:	WA
Zip	:	98115-2023
Country	:	US
Telephone Number	:	206-527-9100
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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