Provider Demographics
NPI:1578681706
Name:GREEN, DANIEL H (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:H
Last Name:GREEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 VALLEY FORGE RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIXVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19460-2658
Mailing Address - Country:US
Mailing Address - Phone:610-933-7700
Mailing Address - Fax:610-933-4302
Practice Address - Street 1:1150 VALLEY FORGE RD
Practice Address - Street 2:
Practice Address - City:PHOENIXVILLE
Practice Address - State:PA
Practice Address - Zip Code:19460-2658
Practice Address - Country:US
Practice Address - Phone:610-933-7700
Practice Address - Fax:610-933-4302
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028143L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist