{
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"EIN": null,
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"IsOrgSubpart": "N",
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"ParentOrgTIN": null,
"OrgName": "GREEN DENTAL, PLLC",
"LastName": null,
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"NamePrefix": null,
"NameSuffix": null,
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"FirstLineMailingAddress": "2921 OLD FRANKLIN RD",
"SecondLineMailingAddress": "#1213",
"MailingAddressCityName": "ANTIOCH",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37013-3177",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "615-523-2625",
"MailingAddressFaxNumber": "615-523-2626",
"FirstLinePracticeLocationAddress": "2510 MURFREESBORO PIKE",
"SecondLinePracticeLocationAddress": "7",
"PracticeLocationAddressCityName": "NASHVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37217-3582",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "615-523-2625",
"PracticeLocationAddressFaxNumber": "615-523-2626",
"EnumerationDate": "09/16/2015",
"LastUpdateDate": "09/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GREEN",
"AuthorizedOfficialFirstName": "JONATHAN",
"AuthorizedOfficialMiddleName": "PRESLEY",
"AuthorizedOfficialTitle": "PRESIDENT",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DDS",
"AuthorizedOfficialTelephoneNumber": "61552326254",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "122300000X",
"TaxonomyName": "Dentist",
"LicenseNumber": "8863",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}