Provider Demographics
NPI:1659317253
Name:GREEN, ROBERT F (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:F
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 1:6506 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:CASS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48726-1204
Mailing Address - Country:US
Mailing Address - Phone:989-872-2181
Mailing Address - Fax:989-872-4471
Practice Address - Street 1:6506 CHURCH ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1204
Practice Address - Country:US
Practice Address - Phone:989-872-2181
Practice Address - Fax:989-872-4471
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901011562122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist