Dr. Raymond Allan Green, DDS
Dentist, General Practice in South Boston, VA. Individual provider (NPI-1).
NPI number1104934751
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1104934751
- Entity type
- Individual (NPI-1)
- Name
- Dr. Raymond Allan Green
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 25, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 0401005893 | VA | Yes |
Practice location
410 Mineral StSouth Boston, VA 24592
Phone 434-572-4928
Mailing address
Po Box 269South Boston, VA 24592
Phone 434-572-4928
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