Individual
DR. RYAN Q. GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
1904 PINE ST, SUITE 1-D, ABILENE, TX 79601-2449
(325) 232-8939
(325) 232-8943
Mailing address
1904 PINE ST, SUITE 1-D, ABILENE, TX 79601-2449
(325) 232-8939
(325) 232-8943
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
24237
TX
174400000X
Specialist
N4439
TX
208600000X
Surgery Physician
N4439
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2119414-01
—
TX
Enumeration date
11/16/2007
Last updated
11/19/2012
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