Green Dental

NPI #1134615347 in Lyons, Indiana

Provider Information

NPI Number: 1134615347
Entity Type: Organization
Organization Name: Green Dental
Primary Specialty: Dentist
Enumeration Date: Jul 11, 2018
Last Updated: Jul 11, 2018

Practice Location

Address: 147 E BROAD ST
City: Lyons
State: Indiana
ZIP Code: 47443-9502
Phone: (812) 659-2111

Authorized Official

Name: DR. BROOKS ANDREW GREEN, DDS
Title: DENTIST, PART OWNER
Phone: (812) 699-0889

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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