Provider Demographics
NPI:1801912712
Name:GREEN, STEVE MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:MICHAEL
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4745 STATESMEN DR STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5649
Mailing Address - Country:US
Mailing Address - Phone:317-482-7900
Mailing Address - Fax:317-863-0066
Practice Address - Street 1:4745 STATESMEN DR STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5649
Practice Address - Country:US
Practice Address - Phone:317-482-7900
Practice Address - Fax:317-863-0066
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN85751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice