Green Dental | |
147 E Broad St Lyons IN 47443-9502 | |
(812) 659-2111 | |
(812) 659-2808 |
Full Name | Green Dental |
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Speciality | Dentist |
Location | 147 E Broad St, Lyons, Indiana |
Authorized Official Name and Position | Brooks Andrew Green (DENTIST, PART OWNER) |
Authorized Official Contact | 8126990889 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Green Dental 147 E Broad St Lyons IN 47443-9502 Ph: (812) 659-2111 | Green Dental 147 E Broad St Lyons IN 47443-9502 Ph: (812) 659-2111 |
NPI Number | 1134615347 |
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Provider Enumeration Date | 07/11/2018 |
Last Update Date | 07/11/2018 |
Identifier | Type | State | Issuer |
---|---|---|---|
1134615347 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | 12012283A (Indiana) | Primary |