Organization
GOODWIN & GREEN DENTISTRY PARTNERSHIP
Active
Other names
Park Place Dental Iuka
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERRY BOWEN GREEN DMD (PARTNER)
(662) 660-7142
Entity
Organization
Contact information
Practice address
915 BATTLEGROUND DR, IUKA, MS 38852-1320
(662) 660-7142
(662) 660-7145
Mailing address
915 BATTLEGROUND DR, IUKA, MS 38852-1320
(662) 660-7142
(662) 660-7145
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
3373-06
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00064011
—
MS
05
—
01234014
—
MS
05
—
03253066
—
MS
05
—
05973097
—
MS
Enumeration date
04/28/2009
Last updated
04/28/2009
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