Individual
PETER GERARD GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2500 N ROSE ST, FLAGSTAFF, AZ 86004-3659
(928) 213-6151
(928) 773-0629
Mailing address
PO BOX 3630, FLAGSTAFF, AZ 86003-3630
(928) 213-6121
(928) 213-6136
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D7215
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DEN02602
LICENSE NO
RI
Enumeration date
07/02/2007
Last updated
07/08/2007
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