Goodwin & Green Dentistry Partnership

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3373-06 Issued in MS

Legal business name

GOODWIN & GREEN DENTISTRY PARTNERSHIP

Practice address

915 Battleground Dr
Iuka, MS 38852-1320

Phone

(662) 660-7142

Fax

(662) 660-7145

NPI assigned

Apr 28, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Gerry Bowen Green, DMD

Title

Partner

Phone

(662) 660-7142

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Park Place Dental Iuka Doing business as

Locations

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

{
    "created_epoch": "1240876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240876800000",
    "number": "1982848446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 BATTLEGROUND DR",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388521320",
            "telephone_number": "662-660-7142",
            "fax_number": "662-660-7145"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "915 BATTLEGROUND DR",
            "city": "IUKA",
            "state": "MS",
            "postal_code": "388521320",
            "telephone_number": "662-660-7142",
            "fax_number": "662-660-7145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOODWIN & GREEN DENTISTRY PARTNERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-28",
        "last_updated": "2009-04-28",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "GERRY",
        "authorized_official_middle_name": "BOWEN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "662-660-7142",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3373-06",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03253066",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00064011",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05973097",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01234014",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Place Dental Iuka",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Morgan Franklin
• Nelson Jackson Fuller III
• Chasity H. George
• Hilary Ashton Glover, CRNP, DNP
• Margaret M Glynn, M.D.
• Tara Cochran Grall, LPC, RPT
• William G Grall, LPC
• Taylor Graves
• Phillip Adam Gray, O. D.
• Erin McGraw Green, FNP-BC

• General Practice Dentistry in Iuka, MS
• Providers in Iuka, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2009; 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.