Provider Demographics
NPI:1700809654
Name:GREEN, WILLIAM ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ALLEN
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 1:810 MAQUAM SHORE RD
Mailing Address - Street 2:
Mailing Address - City:SWANTON
Mailing Address - State:VT
Mailing Address - Zip Code:05488-8416
Mailing Address - Country:US
Mailing Address - Phone:802-524-0930
Mailing Address - Fax:
Practice Address - Street 1:44 MAIN ST
Practice Address - Street 2:RICHFORD DENTAL CLINIC
Practice Address - City:RICHFORD
Practice Address - State:VT
Practice Address - Zip Code:05476-1153
Practice Address - Country:US
Practice Address - Phone:802-255-5563
Practice Address - Fax:802-255-5569
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0160064702122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist