Organization
GREEN DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BROOKS ANDREW GREEN DDS (DENTIST, PART OWNER)
(812) 699-0889
Entity
Organization
Contact information
Practice address
147 E BROAD ST, LYONS, IN 47443-9502
(812) 659-2111
(812) 659-2808
Mailing address
147 E BROAD ST, LYONS, IN 47443-9502
(812) 659-2111
(812) 659-2808
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
12012283A
IN
Other
Enumeration date
07/11/2018
Last updated
07/11/2018
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