Individual
JUSTIN A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2241 STATE ST STE C, NEW ALBANY, IN 47150-4949
(812) 945-5100
Mailing address
8118 SYCAMORE CREEK DR, LOUISVILLE, KY 40222-3937
(740) 525-1125
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
10759
TN
1223G0001X
General Practice Dentistry
Primary
12013955A
IN
Other
Enumeration date
06/10/2018
Last updated
11/30/2022
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