Green, Gerry Bowen

Green, Gerry Bowen is an individual health care provider with primary practice located at 144 S Thomas St , Tupelo MS 38801-5312. He recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / Endodontics. Dental Providers / Endodontics is his primary health care specialty. Green, Gerry Bowen can be contacted via phone (662) 840-4422.

Contact Information

Primary practice address
144 S Thomas St Tupelo MS 38801-5312
Phone: (662) 840-4422
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 5885 Alabama
Dental Providers / Endodontics 1223E0200X 3373-06 Mississippi

Profile Details

NPI number 1184792160
LBN Legal business name Green, Gerry Bowen
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 30th, 2006
Last updated Jul 13th, 2014 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1184792160 NPPES
Mississippi MEDICAID 05973097

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