NPIMap

Organization Active NPI

John Green Dentistry PC

Doing business as Mountain Ridge Dental

  • Dental Clinic/Center
  • Orem, UT
National Provider Identifier
1417240888
Registry record updated May 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
7692415-9922 Issued in UT
Legal business name
JOHN GREEN DENTISTRY PC
Doing business as
Mountain Ridge Dental
Practice address
1256 S State St
Suite 103
Orem, UT 84097-8237
Phone
(801) 224-7182
Fax
(801) 235-0835
NPI assigned
May 18, 2011
Last updated
May 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 18, 2011

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

Authorized official

Name
Dr. John Green, DMD
Title
Owner, Doctor
Phone
(801) 224-7182

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 7692415-9922 UT Primary

Addresses

Primary practice location

1256 S State St
Suite 103
Orem, UT 84097-8237

Mailing address

1256 S State St
Suite 103
Orem, UT 84097-8237
Phone (801) 224-7182

Other names 1

  • Mountain Ridge Dental Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1305676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305676800000",
    "number": "1417240888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1256 S STATE ST",
            "address_2": "SUITE 103",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840978237",
            "telephone_number": "801-224-7182",
            "fax_number": "801-235-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1256 S STATE ST",
            "address_2": "SUITE 103",
            "city": "OREM",
            "state": "UT",
            "postal_code": "840978237",
            "telephone_number": "801-224-7182",
            "fax_number": "801-235-0835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN GREEN DENTISTRY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-18",
        "last_updated": "2011-05-18",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER, DOCTOR",
        "authorized_official_telephone_number": "801-224-7182",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "UT",
            "license": "7692415-9922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain Ridge Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orem, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2011; 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.