Provider Demographics
NPI:1952493660
Name:GREEN, JOHN WHITCOMB (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WHITCOMB
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 N 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2202
Mailing Address - Country:US
Mailing Address - Phone:317-773-3888
Mailing Address - Fax:317-773-3888
Practice Address - Street 1:140 N 10TH STREET
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2202
Practice Address - Country:US
Practice Address - Phone:317-773-3888
Practice Address - Fax:317-773-3888
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007024A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN12007024BOtherSTATE DRUG LICENSE
AG8168709OtherFEDERAL DRUG LICENSE