Provider Demographics
NPI:1811027378
Name:JAY C GREEN, D.D.S. P.A.
Entity Type:Organization
Organization Name:JAY C GREEN, D.D.S. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-581-9550
Mailing Address - Street 1:7500 N.W. 5 STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1612
Mailing Address - Country:US
Mailing Address - Phone:954-581-9550
Mailing Address - Fax:
Practice Address - Street 1:7500 N.W. 5 STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1612
Practice Address - Country:US
Practice Address - Phone:954-581-9550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40991223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty