Provider Demographics
NPI:1548469562
Name:GREEN, MICHAEL S (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
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 1:2244 GREEN HEDGES WAY
Mailing Address - Street 2:STE #102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-8189
Mailing Address - Country:US
Mailing Address - Phone:813-973-1440
Mailing Address - Fax:
Practice Address - Street 1:2244 GREEN HEDGES WAY
Practice Address - Street 2:STE #102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-8189
Practice Address - Country:US
Practice Address - Phone:813-973-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00129051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice