Organization
DEREK GREEN DMD LLC
Active
Parent organization
DEREK GREEN DMD LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
DEREK GREEN DMD LLC
Authorized official
DR. DEREK THOMAS GREEN DMD (OWNER)
(480) 370-0696
Entity
Organization
Contact information
Practice address
4361 BONIFACE PKWY, ANCHORAGE, AK 99504-4314
(907) 333-1211
(907) 743-2925
Mailing address
4361 BONIFACE PKWY, ANCHORAGE, AK 99504-4314
(907) 333-1211
(907) 743-2925
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1684562
—
AK
Enumeration date
06/10/2021
Last updated
06/10/2021
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