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Individual
DR. GARY WAYNE GREEN
Active
Individual
DR. GARY WAYNE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22605
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
954297884
CORP ID #
CA
Enumeration date
06/13/2006
Last updated
09/05/2011
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