Provider Demographics
NPI:1104023373
Name:GREEN, STEVEN (DDS)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8284 W UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8170
Mailing Address - Country:US
Mailing Address - Phone:623-362-8200
Mailing Address - Fax:623-362-8244
Practice Address - Street 1:8284 W UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8170
Practice Address - Country:US
Practice Address - Phone:623-362-8200
Practice Address - Fax:623-362-8244
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ26361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice