Skip Navigation

Provider Information for 1972584969

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. ANTHONY TREVOR GREEN D. D. S.

Gender: MALE

Individual NPI: 1972584969

Calendar   Last Updated:  2014-03-20
  Certification Date: 

Details

Name Value
NPI 1972584969
Enumeration Date 2005-11-08
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 17836 WEXFORD TER SUITE 2E
JAMAICA, NY 11432-3024
United States

Phone: 718-739-1300 | Fax: 718-739-0966
View Map External Link
Primary Practice Address 17836 WEXFORD TER SUITE 2E
JAMAICA, NY 11432-3024
United States

Phone: 718-739-1300 | Fax: 718-739-0966
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
MEDICAID NY 02166558
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 1223S0112X - Dentist Oral and Maxillofacial Surgery NY 0473299