Individual
MS. KELLIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.D.H.
Contact information
Practice address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
Mailing address
2073 OLYMPIC ST, SPRINGFIELD, OR 97477-3413
(541) 682-3550
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
H6106
OR
Other
Enumeration date
11/22/2011
Last updated
11/28/2011
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