Organization
BRETMGREENDDSPC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRET MICHAEL GREEN DDS (DR.)
(505) 299-9606
Entity
Organization
Contact information
Practice address
8501 CANDELARIA RD NE, SUITE A2, ALBUQUERQUE, NM 87112-1034
(505) 299-9606
Mailing address
8501 CANDELARIA RD NE, SUITE A2, ALBUQUERQUE, NM 87112-1034
(505) 299-9606
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD2141
NM
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DD2322
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9177740
—
NM
05
—
92935001
—
NM
Enumeration date
09/09/2008
Last updated
09/09/2008
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