Provider Demographics
NPI:1649413113
Name:GREEN, DENA NIGEL
Entity Type:Individual
Prefix:
First Name:DENA
Middle Name:NIGEL
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 HAVERWOOD LN
Mailing Address - Street 2:APT 1224
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-4227
Mailing Address - Country:US
Mailing Address - Phone:214-708-5173
Mailing Address - Fax:972-448-8532
Practice Address - Street 1:4701 HAVERWOOD LN
Practice Address - Street 2:APT 1224
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-4227
Practice Address - Country:US
Practice Address - Phone:214-708-5173
Practice Address - Fax:972-448-8532
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator