Individual
DR. JACK L GREEN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS MSD
Contact information
Practice address
1201 48TH AVE N, MYRTLE BEACH, SC 29577-5432
(843) 449-1444
(843) 449-2768
Mailing address
1201 48TH AVE N, MYRTLE BEACH, SC 29577-5432
(843) 449-1444
(843) 449-2768
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
1629
SC
Other
Enumeration date
03/21/2007
Last updated
07/08/2007
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