Active NPI
Jerry Allan Green, D.D.S.
- Endodontics
- Los Angeles, CA
National Provider Identifier
1437295284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- 17833
- Practice address
- 3932 Wilshire Blvd
Suite 100
Los Angeles, CA 90010-3307 - Phone
- (213) 386-3336
- Fax
- (213) 386-2935
- NPI assigned
- Jan 29, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | 17833 | CA | Primary |
Addresses
Primary practice location
3932 Wilshire Blvd
Suite 100
Los Angeles, CA 90010-3307
Mailing address
PO Box 674
Woodland Hills, CA 91365-0674
Phone (818) 216-9979
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 17833 | Other | CA | DENTAL LICENCE |
Other names 1
- Dr. Gerald Allan Green
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kaplan Dental Corporation | Past | Accepting new patients | |
| Gregory D. Kaplan,DDS | Endodontics | Past | Accepting new patients |
Organizations & group practices 2
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.
-
dba Wilshire Center Dental Group
- Dentist
- Los Angeles, CA
- NPI 1528070703
Endodontics
-
- Dentist
- Los Angeles, CA
- NPI 1457139057
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170028800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1437295284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 674",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913650674",
"telephone_number": "818-216-9979",
"fax_number": "818-222-9972"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3932 WILSHIRE BLVD",
"address_2": "SUITE 100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900103307",
"telephone_number": "213-386-3336",
"fax_number": "213-386-2935"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JERRY",
"middle_name": "ALLAN",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-01-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "CA",
"license": "17833",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENCE",
"identifier": "17833",
"state": "CA"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "GERALD",
"last_name": "GREEN",
"middle_name": "ALLAN",
"prefix": "DR.",
"credential": "D.D.S.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.