Organization
RANDI GREEN D.M.D., LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDI C. GREEN D.M.D (OWNER/ DENTIST)
(417) 887-5155
Entity
Organization
Contact information
Practice address
2053 S WAVERLY AVE STE E, SPRINGFIELD, MO 65804-2497
(417) 887-5155
(417) 823-7497
Mailing address
2053 S WAVERLY AVE STE E, SPRINGFIELD, MO 65804-2497
(417) 887-5155
(417) 823-7497
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2011012315
MO
Other
Enumeration date
05/10/2011
Last updated
05/10/2011
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