Provider Demographics
NPI:1023510518
Name:RALPH M. GREEN MEDICAL PLLC
Entity type:Organization
Organization Name:RALPH M. GREEN MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:502-459-4273
Mailing Address - Street 1:3809 POPLAR LEVEL RD STE B
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1429
Mailing Address - Country:US
Mailing Address - Phone:502-459-4273
Mailing Address - Fax:502-459-4343
Practice Address - Street 1:3809 POPLAR LEVEL RD STE B
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1429
Practice Address - Country:US
Practice Address - Phone:502-459-4273
Practice Address - Fax:502-459-4343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty