Individual
DR. KOURTENAY V GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
3535 S JEFFERSON AVE, SAINT LOUIS, MO 63118-3930
(314) 268-6135
(314) 268-6117
Mailing address
5920 PARK LN, SAINT LOUIS, MO 63147-1116
(314) 869-6900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2004013239
MO
Other
Enumeration date
01/17/2007
Last updated
07/09/2007
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