Provider Demographics
NPI:1477113975
Name:GREEN, ALEX COLBY (DMD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:COLBY
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:PO BOX 100181
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3141
Mailing Address - Country:US
Mailing Address - Phone:828-202-5200
Mailing Address - Fax:
Practice Address - Street 1:77 MCDOWELL ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4435
Practice Address - Country:US
Practice Address - Phone:828-257-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-17
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11429122300000X, 1223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
No122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice