Robert Tyler Green, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

18952 Issued in TX

Practice address

1805 W White Oak Terrace
Suite a
Conroe, TX 77304-3950

Phone

(936) 588-4433

Fax

(936) 588-4603

NPI assigned

Oct 11, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dental Health Associates of Texas, PC.

  • General Practice Dentistry
  • Conroe, TX
  • NPI 1376776807

  General Practice

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160524800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203984000000",
    "number": "1043308331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 W WHITE OAK TERRACE",
            "address_2": "SUITE A",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043950",
            "telephone_number": "936-588-4433",
            "fax_number": "936-588-4603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 W WHITE OAK TERRACE",
            "address_2": "SUITE A",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773043950",
            "telephone_number": "936-588-4433",
            "fax_number": "936-588-4603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ROBERT",
        "middle_name": "TYLER",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-11",
        "last_updated": "2008-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "18952",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "18952",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Greater Houston Family Medicine, PLLC
• Greater Houston Pediatric Dentistry-Conroe PLLC
• Lauren Emily Gredicek
• Olivia Green
• Patricia Green, MSN, RN, FNP
• Serra Green, LPC
• Shawn Green
• Karrie Greenawalt, LPC
• Lindsey Greenfield
• Kimberly Corinne Greenhouse, LVN

• All providers in Conroe, TX
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.