Individual
DR. JAMES RUSSELL GREEN IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1309 W FLETCHER AVE, TAMPA, FL 33612
(813) 960-5540
Mailing address
1309 W FLETCHER AVE, TAMPA, FL 33612
(813) 960-5540
(813) 961-1599
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
18270
FL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
P64379
NY
390200000X
Student in an Organized Health Care Education/Training Program
P64379
NY
Other
Enumeration date
05/15/2009
Last updated
03/27/2018
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