Kristin Dyan Green, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

2014015540 Issued in MO

Practice address

2209 Oak Ridge Dr
Neosho, MO 64850-9092

Phone

(417) 451-0977

Fax

(417) 451-0977

NPI assigned

Jul 1, 2009

Sex

Female

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

Enrolled in MO

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

Locations

Interoperability endpoints

• Direct secure messaging: kristin.green@othcdafc.eclinicaldirectplus.com

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.

• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Neosho, MO
  • NPI 1013368984

  General Practice

  NPD
• Ozark Tri-County Health Care Consortium

  • Federally Qualified Health Center (FQHC)
  • Joplin, MO
  • NPI 1649837444
  NPD (past)

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

{
    "created_epoch": "1246406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1356579080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 758",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648500758",
            "telephone_number": "417-451-9450",
            "fax_number": "417-451-8903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 OAK RIDGE DR",
            "city": "NEOSHO",
            "state": "MO",
            "postal_code": "648509092",
            "telephone_number": "417-451-0977",
            "fax_number": "417-451-0977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "KRISTIN",
        "middle_name": "DYAN",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-07-01",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2014015540",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3730",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "180656608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jenny Kay Gilbert, BCABA
• Scott Theodor Godbersen, DC
• Jeffrey Tyler Gossett, DDS
• Majel Gramm
• Colton Green, PTA
• Julie Gummelt
• Mark Allen Haen, D.O.
• Rick L Haggard, DO
• Carolyn Pflug Hale, MS
• Amanda Hall, LPC

• Dentist in Neosho, MO
• Providers in Neosho, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2024; 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.