Provider Demographics
NPI:1932433927
Name:GREEN, NATHAN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
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 1:257 JOHNSTOWN CENTER DR UNIT 107
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-7847
Mailing Address - Country:US
Mailing Address - Phone:816-806-1664
Mailing Address - Fax:319-335-7451
Practice Address - Street 1:257 JOHNSTOWN CENTER DR UNIT 107
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-7847
Practice Address - Country:US
Practice Address - Phone:970-699-5699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-24
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6770122300000X
CODEN.002018231223P0221X
CO002018231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist