Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN015180 | GA |
NPI | 1144762089 |
---|---|
Provider Name | Megan Green |
First Address | Richmond, VA 23221-1734 |
Second Address | Richmond, VA 23298-5064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2016 |
Last Update Date | 09/11/2016 |