Individual
BEVERLY GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
9440 W COMMERCIAL BLVD STE 105, TAMARAC, FL 33351-4329
(954) 900-3180
(954) 440-4388
Mailing address
1841 LYONS RD APT 204, COCONUT CREEK, FL 33063-9269
(954) 854-9753
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN20478
FL
Other
Enumeration date
04/12/2013
Last updated
02/10/2020
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