Provider Demographics
NPI:1972712321
Name:DRS ELROD GREEN DDS PA
Entity Type:Organization
Organization Name:DRS ELROD GREEN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELROD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-437-8208
Mailing Address - Street 1:800 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912
Mailing Address - Country:US
Mailing Address - Phone:507-437-8208
Mailing Address - Fax:507-433-7348
Practice Address - Street 1:800 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912
Practice Address - Country:US
Practice Address - Phone:507-437-8208
Practice Address - Fax:507-433-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN75371223G0001X
MN91111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty