Austin Revvie Green, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

33131 Issued in TX

Practice address

7911 Woodway Dr
Waco, TX 76712-3866

Phone

(254) 772-3632

NPI assigned

Jun 7, 2017

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

Medicare fee-for-service enrollment

Enrolled in CT

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.

• Creekwood Dental Arts, PLLC

  • Dental Clinic/Center
  • Waco, TX
  • NPI 1235735218
  NPD Authorized official
• Donna G Miller DDS PA

  • Dentist
  • Waco, TX
  • NPI 1013913375
  NPD (past)

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

{
    "created_epoch": "1496793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1194254714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7911 WOODWAY DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123866",
            "telephone_number": "254-772-3632",
            "fax_number": "254-772-7856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7911 WOODWAY DR",
            "city": "WACO",
            "state": "TX",
            "postal_code": "767123866",
            "telephone_number": "254-772-3632"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "789 Howard Ave",
            "address_purpose": "LOCATION",
            "city": "New Haven",
            "state": "CT",
            "postal_code": "065191304",
            "country_code": "US",
            "telephone_number": "203-688-2464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "AUSTIN",
        "middle_name": "REVVIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-07",
        "last_updated": "2022-07-21",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "33131",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert W Grayson, M.D.
• Greater Love Ministries
• Greater Texas Behavioral Clinic LLC
• Greater Waco Counseling & Wellness, PLLC
• Green Eye Associates, PLLC
• Heyward L. Green, PSY.D.
• Keri Elizabeth Green
• Leigh Anne Green, O.D.
• Marsha Jean Green, RPH
• Mary Tanna Green, COTA

• General Practice Dentistry in Waco, TX
• Providers in Waco, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.