Dr. Gerry Bowen Green, DMD
Dentist, Endodontics in Tupelo, MS. Individual provider (NPI-1).
NPI number1184792160
StatusActive
Last updated in NPPESJul 13, 2014
Details
- NPI
- 1184792160
- Entity type
- Individual (NPI-1)
- Name
- Dr. Gerry Bowen Green
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Nov 30, 2006
- Last updated
- Jul 13, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223E0200X | Dentist, Endodontics | 3373-06 | MS | Yes |
| 122300000X | Dentist | 5885 | AL |
Practice location
144 S Thomas StTupelo, MS 38801-5312
Phone 662-840-4422
Mailing address
Po Box 2363Tupelo, MS 38803-2363
Phone 662-840-4422
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