Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4099 | IA |
N | 1223P0106X | Oral and Maxillofacial Pathology | 4099 | IA |
NPI | 1427360015 |
---|---|
Provider Name | Dr. T L Green |
First Address | Iowa City, IA 52242-1001 |
Second Address | Iowa City, IA 52242-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2010 |
Last Update Date | 12/07/2010 |