Individual
JOHN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10735 S CICERO AVE STE 101, OAK LAWN, IL 60453-6210
(708) 422-2426
Mailing address
10735 S CICERO AVE STE 101, OAK LAWN, IL 60453-6210
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
019.033096
IL
Other
Enumeration date
06/15/2021
Last updated
06/15/2021
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