Active NPI
Jon Tyler Green, DMD
- Dentist
- Ft. Sill, OK
National Provider Identifier
1023622347
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D-5147
- Practice address
- USA Dental Health Activity
652 Hamilton Rd.
Ft. Sill, OK 73503 - Phone
- (580) 442-3905
- NPI assigned
- Sep 3, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D-5147 | ID | Primary |
Addresses
Primary practice location
USA Dental Health Activity
652 Hamilton Rd.
Ft. Sill, OK 73503
Mailing address
USA Dental Health Activity
652 Hamilton Rd.
Ft. Sill, OK 73503
Phone (580) 442-3905
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D-5147 | ID | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599091200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599091200000",
"number": "1023622347",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "USA DENTAL HEALTH ACTIVITY",
"address_2": "652 HAMILTON RD.",
"city": "FT. SILL",
"state": "OK",
"postal_code": "73503",
"telephone_number": "580-442-3905"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "USA DENTAL HEALTH ACTIVITY",
"address_2": "652 HAMILTON RD.",
"city": "FT. SILL",
"state": "OK",
"postal_code": "73503",
"telephone_number": "580-442-3905"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JON",
"middle_name": "TYLER",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-03",
"last_updated": "2020-09-03",
"certification_date": "2020-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "ID",
"license": "D-5147",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ft. Sill, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.