Provider Demographics
NPI:1326051376
Name:GREEN, RICHARD BROWNLOW (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BROWNLOW
Last Name:GREEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 VINE ST
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-1641
Mailing Address - Country:US
Mailing Address - Phone:606-432-1773
Mailing Address - Fax:
Practice Address - Street 1:387 TOWN MOUNTAIN ROAD
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1641
Practice Address - Country:US
Practice Address - Phone:606-432-1773
Practice Address - Fax:606-432-1773
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36471223G0001X
FLDN45911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice