Active NPI
Roger Alan Green, DDS
- General Practice Dentistry
- Sun City West, AZ
National Provider Identifier
1639200157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1703
- Practice address
- 13920 W Camino del Sol Ste 9
Sun City West, AZ 85375-4438 - Phone
- (623) 933-5678
- Fax
- (623) 974-4754
- NPI assigned
- Mar 8, 2007
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1703 | AZ | Primary |
Addresses
Primary practice location
13920 W Camino del Sol Ste 9
Sun City West, AZ 85375-4438
Mailing address
13920 W Camino del Sol Ste 9
Sun City West, AZ 85375-4438
Phone (623) 933-5678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151106002186 | AZ | Order and Referring Only - Dentist | 0244540060 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1703 | AZ | MD | Electroneurodiagnostic Specialist/Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639200157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13920 W CAMINO DEL SOL STE 9",
"city": "SUN CITY WEST",
"state": "AZ",
"postal_code": "853754438",
"telephone_number": "623-933-5678",
"fax_number": "623-974-4754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13920 W CAMINO DEL SOL STE 9",
"city": "SUN CITY WEST",
"state": "AZ",
"postal_code": "853754438",
"telephone_number": "623-933-5678",
"fax_number": "623-974-4754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "ROGER",
"middle_name": "ALAN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AZ",
"license": "1703",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sun City West, AZ
- Grafted Care LLC (Senior Helpers of Sun City West-Surprise)
- Grandview Surgical Associates PC
- Victoria Grannis, RBT
- Aspen Leigh Grant, MED, BCBA
- Greatcare and Wellness LLC
- Valencia Anquenette Green, L.M.T.
- Danielle Rose Greenfield, PT, DPT
- Tasha Grissett, PA
- James W Groff, DO
- Katherine Elizabeth Gross, M.D.
Sources for this page
- 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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.