Green Valley Oral Surgery and Dental Implant Center

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

Legal business name

GREEN VALLEY ORAL SURGERY AND DENTAL IMPLANT CENTER

Practice address

5140 Business Center Dr Ste 120
Fairfield, CA 94534-1794

Phone

(707) 800-3114

NPI assigned

Jan 23, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Yahya Radwan

Title

Partner

Phone

(408) 221-9333

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1548201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548201600000",
    "number": "1689138703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5140 BUSINESS CENTER DR STE 120",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945341794"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5140 BUSINESS CENTER DR STE 120",
            "city": "FAIRFIELD",
            "state": "CA",
            "postal_code": "945341794",
            "telephone_number": "707-800-3114"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5140 Business Center Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CA",
            "postal_code": "945341794",
            "country_code": "US",
            "telephone_number": "707-800-3114",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5140 Business Center Dr Ste 120",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CA",
            "postal_code": "945341794",
            "country_code": "US",
            "telephone_number": "707-800-3114",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREEN VALLEY ORAL SURGERY AND DENTAL IMPLANT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-23",
        "last_updated": "2019-01-23",
        "status": "A",
        "authorized_official_last_name": "RADWAN",
        "authorized_official_first_name": "YAHYA",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "408-221-9333",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Corey Lamar Grayson
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• Adrienne Green
• Ashley Green
• Daniel E Green, MD
• David L. Green, PH.D.
• Hayley Green

• Oral and Maxillofacial Pathology Dentistry in Fairfield, CA
• Providers in Fairfield, CA by specialty
• Oral and Maxillofacial Pathology Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2019; 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.