Provider Demographics
NPI:1043689367
Name:GREEN DENTAL, PLLC
Entity Type:Organization
Organization Name:GREEN DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:PRESLEY
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:6155-232-6254
Mailing Address - Street 1:2921 OLD FRANKLIN RD
Mailing Address - Street 2:#1213
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-3177
Mailing Address - Country:US
Mailing Address - Phone:615-523-2625
Mailing Address - Fax:615-523-2626
Practice Address - Street 1:2510 MURFREESBORO PIKE
Practice Address - Street 2:7
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3582
Practice Address - Country:US
Practice Address - Phone:615-523-2625
Practice Address - Fax:615-523-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty