| Edward J Green Dmd Pc | |
|
1505 W Third Avenue Suite B Albany GA 31707-3647 | |
| (229) 883-3071 | |
| (229) 883-5184 |
| Full Name | Edward J Green Dmd Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1505 W Third Avenue, Albany, Georgia |
| Authorized Official Name and Position | Edward James Green (S CORP PRESIDENT) |
| Authorized Official Contact | 2298833071 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Edward J Green Dmd Pc Po Box 70907 Albany GA 31708-0907 Ph: (229) 883-3071 | Edward J Green Dmd Pc 1505 W Third Avenue Suite B Albany GA 31707-3647 Ph: (229) 883-3071 |
| NPI Number | 1770657124 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770657124 | NPI | - | NPPES |
| 00267044B | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DN09807 (Georgia) | Primary |
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