Provider Demographics
NPI:1760179519
Name:LARRY P. GREEN DDS INC., PC
Entity Type:Organization
Organization Name:LARRY P. GREEN DDS INC., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-256-4969
Mailing Address - Street 1:PO BOX 243
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:SD
Mailing Address - Zip Code:57042-0243
Mailing Address - Country:US
Mailing Address - Phone:605-256-4969
Mailing Address - Fax:
Practice Address - Street 1:102 N EGAN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:SD
Practice Address - Zip Code:57042-2909
Practice Address - Country:US
Practice Address - Phone:605-256-4969
Practice Address - Fax:605-256-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-21
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty