Provider Demographics
NPI:1952561219
Name:GREEN, JOEL C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:C
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 1:918 PELHAM PKWY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-1144
Mailing Address - Country:US
Mailing Address - Phone:718-823-7312
Mailing Address - Fax:718-319-0962
Practice Address - Street 1:918 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-1144
Practice Address - Country:US
Practice Address - Phone:718-823-7312
Practice Address - Fax:718-319-0962
Is Sole Proprietor?:No
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0379181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice