Provider Demographics
NPI:1487677134
Name:GREEN, LEON COLBY (DDS)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:COLBY
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 1:140 BOARDWALK DR
Mailing Address - Street 2:#G
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3047
Mailing Address - Country:US
Mailing Address - Phone:970-407-8080
Mailing Address - Fax:970-221-3590
Practice Address - Street 1:140 BOARDWALK DR
Practice Address - Street 2:#G
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3047
Practice Address - Country:US
Practice Address - Phone:970-407-8080
Practice Address - Fax:970-221-3590
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO81861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice