Provider Demographics
NPI:1922025634
Name:RALPH GREEN DDS, PC
Entity Type:Organization
Organization Name:RALPH GREEN DDS, PC
Other - Org Name:REACHOUT HEALTHCARE AMERICA
Other - Org Type:Other Name
Authorized Official - Title/Position:CREDENTIALING COORDATOR
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RAZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-434-9343
Mailing Address - Street 1:1904 W PARKSIDE LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-1228
Mailing Address - Country:US
Mailing Address - Phone:623-434-9343
Mailing Address - Fax:
Practice Address - Street 1:1904 W PARKSIDE LN
Practice Address - Street 2:SUITE 201
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85027-1228
Practice Address - Country:US
Practice Address - Phone:623-434-9343
Practice Address - Fax:623-434-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty