Individual
MARK A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DN1857060
MA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
274122
MA
Other
Enumeration date
06/29/2012
Last updated
04/04/2023
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