Rhonda Nicole Green, DMD
Individual provider Active NPI Dentist · Godfrey, IL
NPI 1467540906 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1467540906
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 019024529 (IL)
- Practice address
- 3003 Godfrey Rd
Godfrey, IL 62035-1808 - Phone
- (618) 466-5508
- Fax
- (618) 466-3515
- NPI assigned
- Oct 10, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019024529 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All Smiles Dental Care | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 019024529 | IL | Yes |
Addresses
Primary practice location
3003 Godfrey Rd
Godfrey, IL 62035-1808
Mailing address
3003 Godfrey Rd
Godfrey, IL 62035-1808
Phone (618) 466-5508
Other providers in Godfrey, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.