MEDICARE: DR. GARY WAYNE 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	1223P0300X	Periodontics	22605	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	954297884	OTHER	CA	CORP ID #

General Provider Information

NPI Number	:	1992748529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY WAYNE GREEN DDS

Provider Business Mailing Address
First Line	:	16133 VENTURA BLVD
Second Line	:	SUITE 1040
City	:	ENCINO
State	:	CA
Zip	:	91436-2403
Country	:	US
Telephone Number	:	818-995-0294
Fax Number	:	818-995-7549

Provider Business Practice Location Address
First Line	:	16133 VENTURA BLVD
Second Line	:	SUITE 1040
City	:	ENCINO
State	:	CA
Zip	:	91436-2403
Country	:	US
Telephone Number	:	818-995-0294
Fax Number	:	818-995-7549

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	09/05/2011

Similar Medicare Providers

1720026420 — DR. KHRISTINE ELAINE EROSHEVICH M.D.
Practice Location Address:

16133 VENTURA BLVD , SUITE 1220
ENCINO, CA
91436-2403

Practice Phone: 818-784-2011
Practice Fax: 818-784-2077

1861415499 — GERALD M WEINGARTEN M.D.
Practice Location Address:

16133 VENTURA BLVD , #400
ENCINO, CA
91436-2403

Practice Phone: 818-986-1357
Practice Fax: 818-986-3282

1386667145 — DR. TONY FRAZER FEUERMAN M.D.
Practice Location Address:

16133 VENTURA BOULEVARD , SUITE 1105
ENCINO, CA
91436-2403

Practice Phone: 818-905-9642
Practice Fax: 818-905-7428

1306860416 — DR. MELVIN T. MONSHER M.D.
Practice Location Address:

16133 VENTURA BLVD , SUITE 250
ENCINO, CA
91436-2403

Practice Phone: 818-990-3370
Practice Fax: 818-990-4703

1013929918 — DR. DARIUS GHARIB M.D.
Practice Location Address:

16133 VENTURA BLVD , 350
ENCINO, CA
91436-2403

Practice Phone: 818-501-5201
Practice Fax: 818-530-5322

1982710810 — JEROME A HAMBURGER M.D.
Practice Location Address:

16133 VENTURA BLVD , SUITE 1180
ENCINO, CA
91436-2403

Practice Phone: 818-990-5665
Practice Fax: 818-905-5426

Directions to “ DR. GARY WAYNE GREEN DDS” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.