Provider Demographics
NPI:1174512479
Name:GREEN, WILLIAM PHILLIP (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PHILLIP
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-4752
Mailing Address - Country:US
Mailing Address - Phone:931-920-3232
Mailing Address - Fax:931-551-9520
Practice Address - Street 1:1573 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3535
Practice Address - Country:US
Practice Address - Phone:931-553-0919
Practice Address - Fax:931-553-0971
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist