Provider Demographics
NPI:1518168285
Name:GREEN, JAMIE H (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:H
Last Name:GREEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 GREEN LN
Mailing Address - Street 2:
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-2846
Mailing Address - Country:US
Mailing Address - Phone:856-582-3898
Mailing Address - Fax:
Practice Address - Street 1:100 HERITAGE VALLEY DR
Practice Address - Street 2:SUITE 3
Practice Address - City:SEWELL
Practice Address - State:NJ
Practice Address - Zip Code:08080-1752
Practice Address - Country:US
Practice Address - Phone:856-582-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI019416001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice