Organization
SOUTH SOUND FAMILY DENTISTRY, PLLC
Active
Other names
South Sound Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEVI G GREEN DDS (PRESIDENT)
(360) 459-3400
Entity
Organization
Contact information
Practice address
703 LILLY RD NE STE 201, OLYMPIA, WA 98506-5256
(360) 459-3400
Mailing address
703 LILLY RD NE STE 201, OLYMPIA, WA 98506-5256
(360) 459-3400
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9986
WA
1223G0001X
General Practice Dentistry
DE00009986
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0215386
L & I GROUP PROVIDER #
WA
Enumeration date
12/18/2006
Last updated
04/19/2016
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