Individual
DR. MARK RAYMOND GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2201 LINCOLN WAY WEST, SOUTH BEND, IN 46628-2513
(574) 232-4990
(574) 232-2470
Mailing address
2201 LINCOLN WAY W, SOUTH BEND, IN 46628-2513
(574) 232-4990
(574) 232-2470
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
12008310
IN
Other
Enumeration date
08/07/2006
Last updated
07/08/2007
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