Provider Demographics
NPI:1407123946
Name:GEORGE GREEN DDS PA
Entity Type:Organization
Organization Name:GEORGE GREEN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:MRS
Authorized Official - First Name:YAJAIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TORRES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-344-8800
Mailing Address - Street 1:1700 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8970
Mailing Address - Country:US
Mailing Address - Phone:954-344-8800
Mailing Address - Fax:954-344-4489
Practice Address - Street 1:1700 N UNIVERSITY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8970
Practice Address - Country:US
Practice Address - Phone:954-344-8800
Practice Address - Fax:954-344-4489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10511122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty