Provider Demographics
NPI:1265456453
Name:GREEN, STEPHEN C (DMD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:C
Last Name:GREEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 NORTH AVENUE, SUITE 103
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-5710
Mailing Address - Country:US
Mailing Address - Phone:203-853-6350
Mailing Address - Fax:203-853-6351
Practice Address - Street 1:37 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-853-6350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0275351223G0001X
CT0042181223X0008X
CT42181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology