Provider Demographics
NPI:1770503195
Name:GREEN & NAHERNAK DDS PC
Entity Type:Organization
Organization Name:GREEN & NAHERNAK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:NAHERNAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PC
Authorized Official - Phone:989-872-2181
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
Mailing Address - Country:US
Mailing Address - Phone:989-872-2181
Mailing Address - Fax:989-872-4471
Practice Address - Street 1:6506 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726
Practice Address - Country:US
Practice Address - Phone:989-872-2181
Practice Address - Fax:989-872-4471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty