Provider Demographics
NPI:1518637156
Name:BRIAN GREEN DMD INC
Entity Type:Organization
Organization Name:BRIAN GREEN DMD INC
Other - Org Name:GREEN DENTAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:949-706-0777
Mailing Address - Street 1:280 NEWPORT CENTER DR STE 230
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7539
Mailing Address - Country:US
Mailing Address - Phone:949-706-0777
Mailing Address - Fax:949-734-7270
Practice Address - Street 1:180 NEWPORT CENTER DR STE 230
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0903
Practice Address - Country:US
Practice Address - Phone:949-706-0777
Practice Address - Fax:949-734-7270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty