Gordon Keith Green, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7342 Issued in IN

Practice address

147 E Broad St
Lyons, IN 47443-9502

Phone

(812) 659-2111

Fax

(812) 659-2808

NPI assigned

Jul 17, 2006

Last updated

Dec 17, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IN

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Green Dental

  • Dentist
  • Lyons, IN
  • NPI 1134615347
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292544000000",
    "number": "1265450464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P O BOX 501",
            "address_2": "147 EAST 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": {
        "last_name": "GREEN",
        "first_name": "GORDON",
        "middle_name": "KEITH",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2010-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "7342",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "457474",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100124690A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Cox
• Elizabeth S. Mateos-Tiongco
• Dorothy Freeman, PTA
• Green Dental
• Brooks Andrew Green, D.D.S
• Stephanie Heinrich, OT
• Laura Jones, PTA
• Linda C Powers, D.D.S., M.S.D
• Scott W Powers, DDS
• William Ray Powers, MD

• General Practice Dentistry in Lyons, IN
• Providers in Lyons, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2010; 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.