Individual
DR. IVAN L GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19551 E 10 MILE RD, ROSEVILLE, MI 48066-3998
(586) 775-6770
Mailing address
29961 NORTHBROOK ST, FARMINGTON HILLS, MI 48334-2328
(248) 797-7795
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2901009700
MI
Other
Enumeration date
01/07/2011
Last updated
01/07/2011
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