Provider Demographics
NPI:1255659132
Name:GREEN, BARRETT WRIGHT (DDS)
Entity Type:Individual
Prefix:
First Name:BARRETT
Middle Name:WRIGHT
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 1:4024 S ROXBORO ST APT 348
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7250
Mailing Address - Country:US
Mailing Address - Phone:919-605-5833
Mailing Address - Fax:
Practice Address - Street 1:4024 S ROXBORO ST APT 348
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7250
Practice Address - Country:US
Practice Address - Phone:919-605-5833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist