Gary Wayne Green, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

22605 Issued in CA

Practice address

16133 Ventura Blvd
Suite 1040
Encino, CA 91436-2403

Phone

(818) 995-0294

Fax

(818) 995-7549

NPI assigned

Jun 13, 2006

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

Enrolled in CA

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

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1315180800000",
    "number": "1992748529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16133 VENTURA BLVD",
            "address_2": "SUITE 1040",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362403",
            "telephone_number": "818-995-0294",
            "fax_number": "818-995-7549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16133 VENTURA BLVD",
            "address_2": "SUITE 1040",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362403",
            "telephone_number": "818-995-0294",
            "fax_number": "818-995-7549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "GARY",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2011-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "22605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CORP ID #",
            "identifier": "954297884",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Great Life Home Care Inc
• Great Life Home Health Inc
• Greater San Gabriel Valley Physicians
• Green Heart Therapy Inc
• Debra Lynn Green, LMFT
• Larry H. Green, MD
• Suzanne H. Green, PHD., MFT
• Noam Moshe Greenbaum, DDS
• Jeanne Greenberg
• Greenburg, DDS, PC

• Periodontics in Encino, CA
• Providers in Encino, CA by specialty
• Periodontics in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2011; 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.