NPIMap

Organization Active NPI

Brad H Green DDS PA

  • General Practice Dentistry
  • Prairie Grove, AR
National Provider Identifier
1457548935
Registry record updated May 2, 2008
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Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3578 Issued in AR
Legal business name
BRAD H GREEN DDS PA
Practice address
401 E Buchanan
Prairie Grove, AR 72753
Phone
(479) 846-1005
NPI assigned
Sep 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2008

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

Authorized official

Name
Dr. Brad Green, DDS
Title
President
Phone
(479) 846-1005

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 3578 AR Primary

Addresses

Primary practice location

401 E Buchanan
Prairie Grove, AR 72753

Mailing address

101 S Pittman St
PO Box 288
Prairie Grove, AR 72753-3247
Phone (479) 846-1005

National Provider Directory

National Provider Directory
Tax ID family
Brad H Green DDS PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1190937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209686400000",
    "number": "1457548935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 S PITTMAN ST",
            "address_2": "PO BOX 288",
            "city": "PRAIRIE GROVE",
            "state": "AR",
            "postal_code": "727533247",
            "telephone_number": "479-846-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E BUCHANAN",
            "city": "PRAIRIE GROVE",
            "state": "AR",
            "postal_code": "72753",
            "telephone_number": "479-846-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRAD H GREEN DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-28",
        "last_updated": "2008-05-02",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "479-846-1005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "3578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prairie Grove, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; 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.