Provider Demographics
NPI:1316066723
Name:GREEN, JAMES ROYCE (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ROYCE
Last Name:GREEN
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 KELL BLVD.
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309
Mailing Address - Country:US
Mailing Address - Phone:940-322-2252
Mailing Address - Fax:940-322-7090
Practice Address - Street 1:2200 KELL BLVD.
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309
Practice Address - Country:US
Practice Address - Phone:940-322-2252
Practice Address - Fax:940-322-7090
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD16192122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist