Provider Demographics
NPI:1235772831
Name:GREEN APPLE DENTISTRY PLLC
Entity Type:Organization
Organization Name:GREEN APPLE DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-826-2392
Mailing Address - Street 1:332 WASHINGTON ST
Mailing Address - Street 2:MEZZANINE LEVEL
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-1431
Mailing Address - Country:US
Mailing Address - Phone:781-222-4738
Mailing Address - Fax:
Practice Address - Street 1:332 WASHINGTON STREET
Practice Address - Street 2:MEZZANINE
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481
Practice Address - Country:US
Practice Address - Phone:405-826-2392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-26
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental