Amanda S. Green, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3703 Issued in SC

Practice address

763 E. Main Street
Spartanburg, SC 29302

Phone

(864) 585-8558

Fax

(864) 580-4242

NPI assigned

Mar 29, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Pediatric Dentistry

  • Dental Clinic/Center
  • Spartanburg, SC
  • NPI 1326332628
  NPD Authorized official

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1588783344",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 E. MAIN STREET",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "29302",
            "telephone_number": "864-585-8558",
            "fax_number": "864-580-4242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "763 E. MAIN STREET",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "29302",
            "telephone_number": "864-585-8558",
            "fax_number": "864-580-4242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "AMANDA",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-29",
        "last_updated": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "SC 3703",
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "SC",
            "license": "738PD",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "3703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9313",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZA9481",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZX3703",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Benjamin Gray, MD
• Pebbles Grayson
• Green Barr Orthodontics LLC
• Emily Catherine Green Flynn, LMFT
• Danetta Latia Patrice Green-McCray, MD
• Anastesia Green, LPC-A
• James F Green, MD
• Jonathan Gregory Green, FNP
• Karen A Green
• Keisa Green, LPC

• General Practice Dentistry in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• General Practice Dentistry in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2024; 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.