Provider Demographics
NPI:1023734050
Name:DAVID GREEN DDS OF LAKE WORTH
Entity type:Organization
Organization Name:DAVID GREEN DDS OF LAKE WORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-800-4828
Mailing Address - Street 1:8746 LAKE WORTH RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467
Mailing Address - Country:US
Mailing Address - Phone:561-800-4828
Mailing Address - Fax:561-899-8280
Practice Address - Street 1:8746 LAKE WORTH RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467
Practice Address - Country:US
Practice Address - Phone:561-800-4828
Practice Address - Fax:561-899-8280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty