Provider Demographics
NPI:1013740018
Name:GREEN 32 PLLC
Entity type:Organization
Organization Name:GREEN 32 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANNON
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUNNELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-570-3502
Mailing Address - Street 1:107 N GREENFIELD RD STE 2
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-7802
Mailing Address - Country:US
Mailing Address - Phone:480-570-3502
Mailing Address - Fax:480-654-9900
Practice Address - Street 1:107 N GREENFIELD RD STE 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-7802
Practice Address - Country:US
Practice Address - Phone:480-832-5190
Practice Address - Fax:480-654-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty