Individual
MR. JOEL D GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
950 W COY SMITH HWY, MOUNT VERNON, AL 36560-3201
(251) 829-9884
(251) 829-9507
Mailing address
251 N BAYOU ST, MOBILE, AL 36603-5827
(251) 690-8158
(251) 544-2188
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
ETD0008
AL
1223G0001X
General Practice Dentistry
Primary
5458C
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011846
MEDICARE GROUP PAYEE NUMBER
AL
01
—
1063439065
NPI GROUP PAYEE NUMBER
AL
05
—
630000013
—
AL
05
—
631400174
—
AL
Enumeration date
05/19/2006
Last updated
02/15/2013
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