Provider Demographics
NPI:1568918142
Name:GREEN, BRITNEY I (DDS)
Entity Type:Individual
Prefix:
First Name:BRITNEY
Middle Name:
Last Name:GREEN
Suffix:I
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 1:1060 HIGHWAY 15 S
Mailing Address - Street 2:SUITE 84
Mailing Address - City:HUTCHINSON
Mailing Address - State:MN
Mailing Address - Zip Code:55350-3157
Mailing Address - Country:US
Mailing Address - Phone:320-234-6677
Mailing Address - Fax:952-471-2421
Practice Address - Street 1:1060 HIGHWAY 15 S
Practice Address - Street 2:SUITE 84
Practice Address - City:HUTCHINSON
Practice Address - State:MN
Practice Address - Zip Code:55350-3157
Practice Address - Country:US
Practice Address - Phone:320-234-6677
Practice Address - Fax:952-471-2421
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND13755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND13755OtherDDS LICENCE