Jack L Green Jr., DDS MSD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

1629 Issued in SC

Practice address

1201 48TH Ave N
Myrtle Beach, SC 29577-5432

Phone

(843) 449-1444

Fax

(843) 449-2768

NPI assigned

Mar 21, 2007

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)

Not enrolled

State licenses

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

{
    "created_epoch": "1174435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770608119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1201 48TH AVE N",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775432",
            "telephone_number": "843-449-1444",
            "fax_number": "843-449-2768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 48TH AVE N",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295775432",
            "telephone_number": "843-449-1444",
            "fax_number": "843-449-2768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JACK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "DDS MSD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "SC",
            "license": "1629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony John Grasso, ADC
• Ellalee F. Gravely, LPC, NCC
• Frances Graves
• Melissa H Gray, P.T.
• Stephanie N Grear, SLP
• Melissa Ann Green, RD
• James Chad Greene, MD
• Jessica Yvonne Greene, LPC
• William R Greene, M.D.
• Joyce A. Greeno, LPN

• Orthodontics and Dentofacial Orthopedics Dentistry in Myrtle Beach, SC
• Providers in Myrtle Beach, SC by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in South Carolina

• 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.