Provider Demographics
NPI:1518099001
Name:GREEN, GEORGE FRANKLIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:FRANKLIN
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 1-C
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2474
Mailing Address - Country:US
Mailing Address - Phone:562-596-1661
Mailing Address - Fax:
Practice Address - Street 1:3551 FLORISTA ST
Practice Address - Street 2:SUITE 1-C
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2474
Practice Address - Country:US
Practice Address - Phone:562-596-1661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27289122300000X
HI1079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist