Provider Demographics
NPI:1275977068
Name:GREEN, CHAD C (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:C
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 1:821 ALLEN ST APT 1111
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-5897
Mailing Address - Country:US
Mailing Address - Phone:602-617-9563
Mailing Address - Fax:
Practice Address - Street 1:821 ALLEN ST APT 1111
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-5897
Practice Address - Country:US
Practice Address - Phone:602-617-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program