| Green Dental | |
|
147 E Broad St Lyons IN 47443-9502 | |
| (812) 659-2111 | |
| (812) 659-2808 |
| Full Name | Green Dental |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| 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 |