Provider Demographics
NPI:1962504001
Name:GREEN, MARTYN STEVEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTYN
Middle Name:STEVEN
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 1:465 N ROXBURY DR
Mailing Address - Street 2:SUITE 911
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4206
Mailing Address - Country:US
Mailing Address - Phone:310-246-0024
Mailing Address - Fax:
Practice Address - Street 1:465 N ROXBURY DR
Practice Address - Street 2:SUITE 911
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4206
Practice Address - Country:US
Practice Address - Phone:310-246-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA343361223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics