Gerry Bowen Green, DMD

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

3373-06 Issued in MS

Practice address

144 S Thomas St
Tupelo, MS 38801-5312

Phone

(662) 840-4422

NPI assigned

Nov 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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": "1164844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1405209600000",
    "number": "1184792160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2363",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388032363",
            "telephone_number": "662-840-4422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "144 S THOMAS ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388015312",
            "telephone_number": "662-840-4422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "GERRY",
        "middle_name": "BOWEN",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-30",
        "last_updated": "2014-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AL",
            "license": "5885",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "MS",
            "license": "3373-06",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05973097",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lenora Lee Grayson, PT, DPT
• Brenda Joyce Grear
• Brandon Grecinger
• Asya Tierra Green
• Charlotte Renae Green, PMHNP-BC
• Jamie Leigh Green, RN
• Teresa Green, RBT
• Bradley Noel Greenhaw, M.D.
• Curtis Greer, MD
• Bryanna Grice

• Endodontics in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Endodontics in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2014; 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.