Peter Gerard Green, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D7215 Issued in AZ

Practice address

2500 N Rose St
Flagstaff, AZ 86004-3659

Phone

(928) 213-6151

Fax

(928) 773-0629

NPI assigned

Jul 2, 2007

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 and National Provider Directory roles.

• North Country Healthcare, Inc.

  • Multi-Specialty Clinic/Center
  • Show Low, AZ
  • NPI 1073740098
  NPD (past)

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

{
    "created_epoch": "1183334400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1902003940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3630",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860033630",
            "telephone_number": "928-213-6121",
            "fax_number": "928-213-6136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N ROSE ST",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860043659",
            "telephone_number": "928-213-6151",
            "fax_number": "928-773-0629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "PETER",
        "middle_name": "GERARD",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D7215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NO",
            "identifier": "DEN02602",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Laurel S. Gray, MD, MS
• Michelle Dereschuk Gray, PH.D.
• John Paul Graziano, M.D.
• Kyler Green, RBT
• Nathaniel Green, PHARMD
• Zachary Tyler Green, OD
• James S Greenan, RPH
• Mark J Greene, D.M.D.
• Michael Cayman Greene, ATC
• Greengate Intensive, LLC

• General Practice Dentistry in Flagstaff, AZ
• Providers in Flagstaff, AZ by specialty
• General Practice Dentistry in Arizona

• 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.