Individual
DR. JERRY ALLAN GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
3932 WILSHIRE BLVD, SUITE 100, LOS ANGELES, CA 90010-3307
(213) 386-3336
(213) 386-2935
Mailing address
PO BOX 674, WOODLAND HILLS, CA 91365-0674
(818) 216-9979
(818) 222-9972
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
17833
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17833
DENTAL LICENCE
CA
Enumeration date
01/29/2007
Last updated
07/08/2007
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