Provider Demographics
NPI:1831313782
Name:GREEN, MICHELLE TERESE (DMD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:TERESE
Last Name:GREEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5122 OLYMPIC DR NW
Mailing Address - Street 2:SUITE B 201
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1767
Mailing Address - Country:US
Mailing Address - Phone:253-851-8151
Mailing Address - Fax:
Practice Address - Street 1:5122 OLYMPIC DR NW
Practice Address - Street 2:SUITE B 201
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1767
Practice Address - Country:US
Practice Address - Phone:253-851-8151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA106501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice