Jasmine Evanna Green, D.M.D

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10793 Issued in SC

Practice address

1099 N Main St Ste 102
Summerville, SC 29483-7300

Phone

(843) 536-8577

Fax

(843) 790-2602

NPI assigned

Apr 19, 2022

Sex

Female

Sole proprietor

No

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

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

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.

• Summerville Smiles Dental Office, PC

  • General Practice Dentistry
  • Summerville, SC
  • NPI 1972179307
  NPD

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721347200000",
    "number": "1821731670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 UPCERNE RD",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294854075",
            "telephone_number": "252-904-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1099 N MAIN ST STE 102",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294837300",
            "telephone_number": "843-536-8577",
            "fax_number": "843-790-2602"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JASMINE",
        "middle_name": "EVANNA",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-19",
        "last_updated": "2024-07-19",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "SC",
            "license": "10793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nakia Grant
• Te'on Grant
• Winter Aliah Grant, M.A.
• Greater Works of Mental Health
• Breland Green, PT, DPT
• Keenan W. Green, D.M.D
• Martha R Green, MS PAS PA-C
• Monique L Green
• Neema N Green
• Salena D Green

• General Practice Dentistry in Summerville, SC
• Providers in Summerville, 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 Jul 19, 2024; 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.

Verify at the official NPI Registry.