Provider Demographics
NPI:1578575189
Name:GREEN, HOLLY ANNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:ANNE
Last Name:GREEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 RIDGELY AVE
Mailing Address - Street 2:STE 225
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1089
Mailing Address - Country:US
Mailing Address - Phone:410-224-9608
Mailing Address - Fax:410-224-9650
Practice Address - Street 1:600 RIDGELY AVE
Practice Address - Street 2:STE 225
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1089
Practice Address - Country:US
Practice Address - Phone:410-224-9608
Practice Address - Fax:410-224-9650
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD114631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice