Individual ProviderDory GreenDentistDental ProvidersPractice Address4100 Davie Rd Ste 104, Davie, FL 33314-3655(954) 682-8000(954) 522-8554PECOS EnrollmentBased on the most recent information from CMS, provider Dory Green does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records today at 10:37 AM.Profile DetailsProvider ID1538459409Provider TypeIndividualFull NameGreen, DoryTitleDr.CredentialDMD, FAGDGenderFemaleSole ProprietorNoEnumeration Date4/13/2011Last Updated5/15/2022Contact InformationPractice LocationPractice Address4100 Davie Rd Ste 104, Davie, FL 33314-3655Phone(954) 682-8000FaxUnlisted FaxMailing LocationMailing Address1313 S Andrews Ave, Fort Lauderdale, FL 33316-1837Phone(954) 522-8554FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicenseDN19577FloridaCode1223G0001XDescriptionDentistDental ProvidersLicenseDS038387PennsylvaniaCode1223G0001XDescriptionDentistDental ProvidersLicense22DI02465100New JerseyProvider IdentifiersIDDescriptionIssuerID008275900DescriptionMedicaidIssuerUnlistedFlorida