Provider Demographics
NPI:1447454988
Name:GREEN, DANIEL JAMES (DDS)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:JAMES
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:ROUTE 313 EXECUTIVE CENTER
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923-0175
Mailing Address - Country:US
Mailing Address - Phone:215-345-0822
Mailing Address - Fax:215-345-7571
Practice Address - Street 1:PA ROUTE 313
Practice Address - Street 2:SUITE 105
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-0175
Practice Address - Country:US
Practice Address - Phone:215-345-0822
Practice Address - Fax:215-345-7571
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037013122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist