Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 11429 | NC |
Y | 1223D0001X | Dental Public Health | 11429 | NC |
NPI | 1477113975 |
---|---|
Provider Name | Dr. Alex Colby Green |
First Address | Spruce Pine, NC 28777-8501 |
Second Address | Bakersville, NC 28705-6502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2019 |
Last Update Date | 24/02/2020 |