Ivan L Green

NPI 1053615831 - Dentist - 1223G0001X

NPI Details
NPI 1053615831
Gender Male
Enumeration Date 01/07/2011
Last Updated 01/07/2011
Entity Type Individual
Active Over 5 years ago
Practice Location
19551 E 10 MILE RD
ROSEVILLE MI, 48066-3998, US
Phone (586) 775-6770
Fax
Business Location
29961 NORTHBROOK ST
FARMINGTON HILLS MI, 48334-2328, US
Phone (248) 797-7795
Fax
Toxanomy
Taxonomy Code 1223G0001X
License State Michigan
License Number 2901009700
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According to our database, Dr. Ivan L Green NPI is 1053615831, taxonomy code is 1223G0001X and license number is 2901009700, license state is located at Michigan. Ivan L Green physically located at 19551 E 10 Mile Rd, Roseville MI, 48066-3998. NPI Number Ivan L Green has the Individual type.

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1053615831 NPI number is provided on an as is basis without warranty of any kind. 1053615831 is maintained by the National Plan & Provider Enumeration System. The contents of Ivan L Green are for informational purposes only.