Individual
DR. GERRY BOWEN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
144 S THOMAS ST, TUPELO, MS 38801-5312
(662) 840-4422
Mailing address
PO BOX 2363, TUPELO, MS 38803-2363
(662) 840-4422
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
5885
AL
1223E0200X
Endodontics
Primary
3373-06
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05973097
—
MS
Enumeration date
11/30/2006
Last updated
07/13/2014
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