Provider Demographics
NPI:1912396441
Name:NEAL C. GREEN, D.D.S.,INC
Entity Type:Organization
Organization Name:NEAL C. GREEN, D.D.S.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MEYER
Authorized Official - Suffix:
Authorized Official - Credentials:RDA
Authorized Official - Phone:661-266-2890
Mailing Address - Street 1:27141 HIDAWAY AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-4141
Mailing Address - Country:US
Mailing Address - Phone:661-251-1320
Mailing Address - Fax:661-266-3464
Practice Address - Street 1:27141 HIDAWAY AVE STE 201
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-4141
Practice Address - Country:US
Practice Address - Phone:661-251-1320
Practice Address - Fax:661-266-3464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty