Individual
MICHAEL BRANDON GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
9217 REDWOOD RD, SUITE B, WEST JORDAN, UT 84088-5826
(801) 566-1873
(801) 307-0215
Mailing address
9217 REDWOOD RD, SUITE B, WEST JORDAN, UT 84088-5826
(801) 566-1873
(801) 307-0215
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6229925
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528373269007
—
UT
Enumeration date
05/10/2007
Last updated
07/09/2007
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