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NPI Code Detail

MEDICARE: DR. KALA MICHELE GREEN D.M.D.

MEDICARE: DR. KALA MICHELE 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
11223G0001XGeneral Practice DentistryDN015201GA

General Provider Information

NPI Number : 1841641701
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KALA MICHELE GREEN D.M.D.
Provider Business Mailing Address
First Line : 3455 LAWRENCEVILLE HWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-4101
Country : US
Telephone Number : 770-921-1115
Fax Number :
Provider Business Practice Location Address
First Line : 3455 LAWRENCEVILLE HWY
Second Line :
City : LAWRENCEVILLE
State : GA
Zip : 30044-4101
Country : US
Telephone Number : 770-921-1115
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2016
Last Update Date : 07/21/2022

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