Provider Demographics
NPI:1811241839
Name:GREEN, LANA S (RDH)
Entity type:Individual
Prefix:
First Name:LANA
Middle Name:S
Last Name:GREEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:LANA
Other - Middle Name:S
Other - Last Name:SCHEETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 W GABRIEL ST
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-8301
Mailing Address - Country:US
Mailing Address - Phone:573-722-3034
Mailing Address - Fax:573-722-3244
Practice Address - Street 1:307 W GABRIEL ST
Practice Address - Street 2:
Practice Address - City:ADVANCE
Practice Address - State:MO
Practice Address - Zip Code:63730-8301
Practice Address - Country:US
Practice Address - Phone:573-722-3034
Practice Address - Fax:573-722-3244
Is Sole Proprietor?:No
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002249124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist