Lacey Montirey Green, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

019027837 Issued in IL

Practice address

8245 S King Dr
Chicago, IL 60619-4903

Phone

(773) 873-7000

Fax

(773) 873-7617

NPI assigned

Sep 5, 2006

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

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

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.

• Barnes Walton Dental Associates LTD

  • General Practice Dentistry
  • Chicago, IL
  • NPI 1669693669
  NPD (past)
• Georgia Dental Professionals, PC

  dba Shadow Brook Dental Care

  • General Practice Dentistry
  • Suwanee, GA
  • NPI 1932351731
  NPD (past)
• Heartland Dental Care of Georgia, P.C.

  dba Braselton Dental Care

  • General Practice Dentistry
  • Braselton, GA
  • NPI 1144659996
  NPD (past)

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235606400000",
    "number": "1952403255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 E 14TH ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606052889",
            "telephone_number": "404-849-6181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8245 S KING DR",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606194903",
            "telephone_number": "773-873-7000",
            "fax_number": "773-873-7617"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "LACEY",
        "middle_name": "MONTIREY",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-05",
        "last_updated": "2009-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019027837",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsey Green, MD, MHS
• Kenisha Green
• Keren Kay Green, NP
• Khalilah Green
• Kristen Green
• Lagretta Green, NP
• Laura Louise Green, LPC
• Lauren Green, M.D.
• Luke D Green, DPT
• Madelyn G Green, LCSW

• Dentist in Chicago, IL
• Providers in Chicago, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2009; 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.