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NPI Code Detail

MEDICARE: JAMES R. GREEN D.D.S,PA

MEDICARE: JAMES R. GREEN D.D.S,PA
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
1122300000XDentistTX10742TX
2122300000XDentistTX16192TX

General Provider Information

NPI Number : 1972911444
Entity Type Code : Organization
Provider Name (Legal Business Name) : JAMES R. GREEN D.D.S,PA
Provider Business Mailing Address
First Line : 2200 KELL BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76309-4401
Country : US
Telephone Number : 940-322-2252
Fax Number : 940-322-7090
Provider Business Practice Location Address
First Line : 2200 KELL BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76309-4401
Country : US
Telephone Number : 940-322-2252
Fax Number : 940-322-7090
Authorized Official
Title or Position : OWNER
Name : JAMES R GREEN
Credential : DDS
Telephone Number : 940-322-2252
Provider Enumeration Date : 07/29/2014
Last Update Date : 08/27/2014

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