Most Relevant Information
Provider Data
| NPI Number: | 1003298076 |
| Provider Name: | BROOKS ANDREW GREEN D.D.S |
| Entity Type: | Individual |
| Taxonomy Code: | 1223G0001X |
| Specialty: | Dentist |
| License Number: | 12012283A |
Most Important Dates
| Enumeration Date: | 06/25/2015 |
| Last Updated: | 06/25/2015 |
Provider Practice Location
147 E BROAD ST
LYONS
IN
474439502
Practice Location Phone/Fax
| Phone: | 8126592111 |
| Fax: |
Provider Mailing Location
147 E BROAD ST
LYONS
IN
474439502
Provider Mailing Phone/Fax
| Phone: | 8126592111 |
| Fax: |