Provider Demographics
NPI:1598921561
Name:GREEN, JONATHAN PRESLEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:PRESLEY
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 MURFREESBORO PIKE STE 7
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3583
Mailing Address - Country:US
Mailing Address - Phone:615-523-2625
Mailing Address - Fax:615-523-2626
Practice Address - Street 1:2510 MURFREESBORO PIKE
Practice Address - Street 2:SUITE 7
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3582
Practice Address - Country:US
Practice Address - Phone:615-523-2625
Practice Address - Fax:615-523-2626
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2009-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN88631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice