Tim Davis Green, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

034421 Issued in NY

Practice address

8135 Soule Rd
Liverpool, NY 13090-1578

Phone

(315) 622-2523

Fax

(315) 622-0594

NPI assigned

Jul 24, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598787301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8135 SOULE RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130901578",
            "telephone_number": "315-622-2523",
            "fax_number": "315-622-0594"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8135 SOULE RD",
            "city": "LIVERPOOL",
            "state": "NY",
            "postal_code": "130901578",
            "telephone_number": "315-622-2523",
            "fax_number": "315-622-0594"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "TIM",
        "middle_name": "DAVIS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "034421",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sara M Gosselin, M.D.
• Ryan Grabiec, FNP-C
• Jenna Megan Grace, LMSW
• Victoria Lynn Graml
• Mary V Green, M.D.
• Seth S Greenky, M.D.
• Charles R Grefer, LMHC
• Michael M Gridley, DDS
• Olivia Griffin, OTR/L
• Stacy Griffith, P.T.

• General Practice Dentistry in Liverpool, NY
• Providers in Liverpool, NY by specialty
• General Practice Dentistry in New York

• 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.

Verify at the official NPI Registry.