Individual
DR. GARY WAYNE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
16133 VENTURA BLVD, SUITE 1040, ENCINO, CA 91436-2403
(818) 995-0294
(818) 995-7549
Mailing address
16133 VENTURA BLVD, SUITE 1040, ENCINO, CA 91436-2403
(818) 995-0294
(818) 995-7549
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
22605
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
954297884
CORP ID #
CA
Enumeration date
06/13/2006
Last updated
09/05/2011
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