# GREEN DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134615347
- **Authorized official:** DR. BROOKS ANDREW GREEN DDS (DENTIST, PART OWNER)
- **Authorized official phone:** (812) 699-0889

## Contact information

- **Practice address:** 147 E BROAD ST, LYONS, IN 47443-9502
- **Practice address phone:** (812) 659-2111
- **Practice address fax:** (812) 659-2808
- **Mailing address:** 147 E BROAD ST, LYONS, IN 47443-9502
- **Mailing address phone:** (812) 659-2111
- **Mailing address fax:** (812) 659-2808

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 12012283A | IN | Yes |

## Other

- **Enumeration date:** 07/11/2018
- **Last updated:** 07/11/2018