Michael Lawrence Green, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

9257847-9921 Issued in UT

Practice address

286 E 12200 S
Draper, UT 84020-7817

Phone

(801) 877-3664

NPI assigned

Nov 17, 2005

Sex

Male

Sole proprietor

Yes

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)

Enrolled

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.

• Michael L Green, DDS, Inc

  • Dentist
  • Sacramento, CA
  • NPI 1134678006
  NPD (past) Authorized official
• 12465 S Fort St Draper Dental LLC

  dba Corner Canyon Family Dental

  • Dental Clinic/Center
  • Draper, UT
  • NPI 1790593051
  NPD (past)

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1932181674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "541 N 580 W",
            "city": "AMERICAN FORK",
            "state": "UT",
            "postal_code": "840033164",
            "telephone_number": "916-241-5515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "286 E 12200 S",
            "city": "DRAPER",
            "state": "UT",
            "postal_code": "840207817",
            "telephone_number": "801-877-3664"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12465 S Fort St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Draper",
            "state": "UT",
            "postal_code": "840208354",
            "country_code": "US",
            "telephone_number": "801-576-1167",
            "fax_number": "801-576-1169",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MICHAEL",
        "middle_name": "LAWRENCE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "9257847-9921",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "34706",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christina Gray
• Cortnie Gray
• Emily Gray
• Jessica Gray
• Coralia Green
• Nicole Green
• William Tim Green
• Nicole Marie Greene, APRN
• Patricia Ann Greene, M.A.
• Stephanie Greer

• Dentist in Draper, UT
• Providers in Draper, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.