Green, Kristin Dyan

Green, Kristin Dyan is an individual health care provider with primary practice located at 1407 N Westwood Blvd , Poplar Bluff MO 63901-3315. She recently has 2 registered licenses in different health care specialties including Dental Providers / General Practice, Dental Providers / Dentist. Dental Providers / Dentist is her primary health care specialty. Green, Kristin Dyan can be contacted via phone (573) 778-3042.

Contact Information

Primary practice address
1407 N Westwood Blvd Poplar Bluff MO 63901-3315
Phone: (573) 778-3042
Fax: (573) 778-9432
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / General Practice 1223G0001X 3730 Arkansas
Dental Providers / Dentist 122300000X 2014015540 Missouri

Profile Details

NPI number 1356579080
LBN Legal business name Green, Kristin Dyan
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 1st, 2009
Last updated Oct 20th, 2016 - about 9 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 1356579080 NPPES
Arkansas MEDICAID 180656608

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