Provider Demographics
NPI:1477821833
Name:GREEN, FRANKLIN PIERCE (DDS)
Entity Type:Individual
Prefix:
First Name:FRANKLIN
Middle Name:PIERCE
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 1:3551 FLORISTA ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2474
Mailing Address - Country:US
Mailing Address - Phone:562-594-6299
Mailing Address - Fax:562-594-6121
Practice Address - Street 1:3551 FLORISTA ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2474
Practice Address - Country:US
Practice Address - Phone:562-594-6299
Practice Address - Fax:562-594-6121
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA316161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice