Michael Brandon Green, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6229925 Issued in UT

Practice address

9217 Redwood Rd
Suite B
West Jordan, UT 84088-5826

Phone

(801) 566-1873

Fax

(801) 307-0215

NPI assigned

May 10, 2007

Last updated

Jul 9, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• South Valley Dental Associates, LLC

  • General Practice Dentistry
  • West Jordan, UT
  • NPI 1780692178
  NPD (past)

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

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1861606584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9217 REDWOOD RD",
            "address_2": "SUITE B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885826",
            "telephone_number": "801-566-1873",
            "fax_number": "801-307-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9217 REDWOOD RD",
            "address_2": "SUITE B",
            "city": "WEST JORDAN",
            "state": "UT",
            "postal_code": "840885826",
            "telephone_number": "801-566-1873",
            "fax_number": "801-307-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MICHAEL",
        "middle_name": "BRANDON",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "6229925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "528373269007",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grateful Direct Primary Care PLLC
• Elizabeth Gray
• Jeffery Gray, D.C.
• Terilee Greeff
• Erin J Green
• Amy Jo Greener
• Wade Greenwood, PT
• Suzanne Marie Greer
• Gregory P. Dupont MD (Utah Sleep Specialists)
• Arielle Grewal

• General Practice Dentistry in West Jordan, UT
• Providers in West Jordan, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 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.