Roosevely T Green Jr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6417VA Issued in VA

Practice address

600 S Green St
Portsmouth, VA 23704

Phone

(757) 399-3752

Fax

(757) 399-2854

NPI assigned

Nov 27, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1164585600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184790826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S GREEN ST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "23704",
            "telephone_number": "757-399-3752",
            "fax_number": "757-399-2854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S GREEN ST",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "23704",
            "telephone_number": "757-399-3752",
            "fax_number": "757-399-2854"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "ROOSEVELY",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-27",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "6417VA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7821701",
            "state": "VI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "138479",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOMINION",
            "identifier": "73",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Greater Passage LLC
• Andrew Green
• Margaret Cecilia Green, D.O.
• Mary Green, DO
• Maxine Cecilia Green, LCSW
• Sandy Charles Green Jr., IDHS
• Tania Green, LPC
• Tanika Chante Green, PHARM.D.
• Ularisi R Green, PHD
• Rachel Lynn Greenberg Seaman, RPH

• General Practice Dentistry in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• General Practice Dentistry in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.