Ty Green, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

12459 Issued in TN

Practice address

23 Garrett Dr
Medina, TN 38355-9639

Phone

(731) 783-1111

NPI assigned

May 22, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not 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.

• Danos Dental, PLLC

  • General Practice Dentistry
  • Bourbonnais, IL
  • NPI 1376375543
  NPD
• Patterson Family Dentistry

  • Dentist
  • Medina, TN
  • NPI 1346579356
  NPD (past)
• Seretis Dental LLC

  • General Practice Dentistry
  • Bourbonnais, IL
  • NPI 1063927176
  NPD (past)

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

{
    "created_epoch": "1684713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734739200000",
    "number": "1851083752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23 GARRETT DR",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383559639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 GARRETT DR",
            "city": "MEDINA",
            "state": "TN",
            "postal_code": "383559639",
            "telephone_number": "731-783-1111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1501 N State Route 50",
            "address_purpose": "LOCATION",
            "city": "Bourbonnais",
            "state": "IL",
            "postal_code": "609144429",
            "country_code": "US",
            "telephone_number": "815-933-7779",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "TY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-05-22",
        "last_updated": "2024-12-21",
        "certification_date": "2024-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019034200",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "12459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• First Choice Medical Care of Medina, Inc.
• Fuller Home Solutions LLC.
• Griffin Brent Gallimore, DDS
• Sonya Carol Goodrich, LCSW
• Whitney L Gower, BCHC
• Bethany Gail Hamilton
• Hart Eyes, PLLC
• Rachel Elizabeth Hart, OD
• Angela Marie Hobbs, D.C.
• Hometown Pharmacy of Medina LLC

• Dentist in Medina, TN
• Providers in Medina, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2024; 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.