Active NPI
Mark Tyler Greene, D.D.S.
- Dentist
- Monument Valley, UT
National Provider Identifier
1467749291
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8012613-9921
- Practice address
- 30 West Medical Drive
Monument Valley, UT 84536 - Phone
- (713) 376-5004
- NPI assigned
- Jun 30, 2011
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8012613-9921 | UT | Primary |
| Dentist | 122300000X | 27972 | TX |
Addresses
Primary practice location
30 West Medical Drive
Monument Valley, UT 84536
Mailing address
PO Box 360005
Monument Valley, UT 84536-0005
Phone (713) 376-5004
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27972 | TX | MD | Dentist |
| 8012613-9921 | UT | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1309392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1348012800000",
"number": "1467749291",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 360005",
"city": "MONUMENT VALLEY",
"state": "UT",
"postal_code": "845360005",
"telephone_number": "713-376-5004"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "30 WEST MEDICAL DRIVE",
"city": "MONUMENT VALLEY",
"state": "UT",
"postal_code": "84536",
"telephone_number": "713-376-5004"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENE",
"first_name": "MARK",
"middle_name": "TYLER",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-06-30",
"last_updated": "2012-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "UT",
"license": "8012613-9921",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "27972",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Monument Valley, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.