NPIMap

Organization Active NPI

Green Dental

  • Dentist
  • Lyons, IN
National Provider Identifier
1134615347
Registry record updated Jul 11, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12012283A Issued in IN
Legal business name
GREEN DENTAL
Practice address
147 E Broad St
Lyons, IN 47443-9502
Phone
(812) 659-2111
Fax
(812) 659-2808
NPI assigned
Jul 11, 2018
Last updated
Jul 11, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2018

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

Authorized official

Name
Dr. Brooks Andrew Green, DDSNPI 1003298076
Title
Dentist, Part Owner
Phone
(812) 699-0889

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12012283A IN Primary

Addresses

Primary practice location

147 E Broad St
Lyons, IN 47443-9502

Mailing address

147 E Broad St
Lyons, IN 47443-9502
Phone (812) 659-2111

National Provider Directory

National Provider Directory

Locations

147 E Broad St
Lyons, IN 47443
Phone (812) 659-2111

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1531267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1531267200000",
    "number": "1134615347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "147 E BROAD ST",
            "city": "LYONS",
            "state": "IN",
            "postal_code": "474439502",
            "telephone_number": "812-659-2111",
            "fax_number": "812-659-2808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 E BROAD ST",
            "city": "LYONS",
            "state": "IN",
            "postal_code": "474439502",
            "telephone_number": "812-659-2111",
            "fax_number": "812-659-2808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREEN DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-11",
        "last_updated": "2018-07-11",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "BROOKS",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "DENTIST, PART OWNER",
        "authorized_official_telephone_number": "812-699-0889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12012283A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lyons, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.