Individual provider Active NPI

Robert E. Green, D.D.S.

  • General Practice Dentistry
  • Delaware, OH
National Provider Identifier
1104865799
Registry record updated Feb 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19247 Issued in OH
Practice address
133 W Hull Dr
Delaware, OH 43015-3703
Phone
(740) 363-3871
Fax
(740) 369-6616
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 19247 OH Primary

Addresses

Primary practice location

133 W Hull Dr
Delaware, OH 43015-3703

Mailing address

133 W Hull Dr
Delaware, OH 43015-3703
Phone (740) 363-3871

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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

Enrollment IDStateProvider typePAC IDDetails
I20130607000321 OH Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 8325286057

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19247OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Robert Green DDS Inc General Practice Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1328054400000",
    "number": "1104865799",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 W HULL DR",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430153703",
            "telephone_number": "740-363-3871",
            "fax_number": "740-369-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 W HULL DR",
            "city": "DELAWARE",
            "state": "OH",
            "postal_code": "430153703",
            "telephone_number": "740-363-3871",
            "fax_number": "740-369-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ROBERT",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2012-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "19247",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Delaware, OH

Sources for this page

Verify at the official NPI Registry.