Provider Demographics
NPI:1245844851
Name:GREEN DENTISTRY, LLC
Entity type:Organization
Organization Name:GREEN DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/CLINICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLENDER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-713-7796
Mailing Address - Street 1:7903 ORION CIR UNIT 359
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20724-3112
Mailing Address - Country:US
Mailing Address - Phone:305-713-7796
Mailing Address - Fax:
Practice Address - Street 1:8611 2ND AVE STE 201
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-6349
Practice Address - Country:US
Practice Address - Phone:301-359-1188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental