Provider Demographics
NPI:1821199241
Name:GREEN, BARRY LEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:LEE
Last Name:GREEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 DENBIGH BLVD
Mailing Address - Street 2:#C2
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-4414
Mailing Address - Country:US
Mailing Address - Phone:757-874-5455
Mailing Address - Fax:757-874-5135
Practice Address - Street 1:716 DENBIGH BLVD
Practice Address - Street 2:#C2
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23608-4414
Practice Address - Country:US
Practice Address - Phone:757-874-5455
Practice Address - Fax:757-874-5135
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA42391223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics