DR. JACK L GREEN JR. (NPI# 1770608119) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770608119 |
| Entity Type | Individual |
| Full Name | DR. JACK L GREEN JR. |
| Credential | DDS MSD |
| Practice Address |
1201 48th Ave N Myrtle Beach SC 29577-5432 |
| Practice Telephone | 8434491444 |
| Practice Fax Number | 8434492768 |
| Mailing Telephone | 8434491444 |
| Mailing Fax Number | 8434492768 |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
1629 | SC | Dental Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043461791 | Jack D Green | Social Worker | 926 W Owens Ave, Las Vegas, NV 89106-2516 | 2008-09-30 |
| 1700326907 | Jack Green | Counselor | 76 Church St, Whitinsville, MA 01588-1464 | 2017-03-07 |
| 1598010399 | Jack Green | Pediatrics | 8700 Beverly Blvd, West Hollywood, CA 90048-1804 | 2012-07-17 |
| 1356402408 | Jack D Green | Social Worker | 1755 Oregon Pike, Suite 200, Lancaster, PA 17601-4272 | 2006-12-13 |
| Street Address |
1201 48TH AVE N |
| City | MYRTLE BEACH |
| State | SC |
| Zip Code | 29577-5432 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750922233 | Vicki Grigg Chacon | Nurse Practitioner | 1201 48th Ave N, Myrtle Beach, SC 29577-5452 | 2019-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124536446 | Well Care Home Health of The Lowcountry | Home Health | 1039 44th Ave N Ste 101, Myrtle Beach, SC 29577 | 2018-01-22 |
| 1518470913 | Guillot Enterprises, LLC | Hearing Instrument Specialist | 1294 Professional Dr., Suite C, Myrtle, SC 29577 | 2017-11-08 |
| 1598288227 | Ryan Shepherd | Pharmacist | 1705 South Kings Highway, Myrtle Beach, SC 29577 | 2017-07-25 |
| 1184176554 | Shannon Long | Counselor | 1293 Professional Drive, Suite D Office 222, Myrtle Beach, SC 29577 | 2016-11-01 |
| 1265898191 | Coastal Carolina Infectious Disease, LLC | Internal Medicine | 1110 London St Ste 102, Myrtle Beach, SC 29577 | 2016-01-07 |
| 1548639933 | Susan Lang | Social Worker | 1273 Professional Dr., Suite A #104, Myrtle Beach, SC 29577 | 2015-09-16 |
| 1043600893 | Kenneth Edward Smith | Counselor | 1125 48th Avenue North, Myrtle Beach, SC 29577 | 2015-02-02 |
| 1902203615 | Sc Nursing Services LLC | Home Infusion | 1297 Professional Drive, Suite 201 C3, Myrtle Beach, SC 29577 | 2014-11-24 |
| 1881007946 | Intercoastal Endo, PC | Dentist | 4382 Oleander Dr, Myrtle Beach, SC 29577 | 2014-06-06 |
| 1891115739 | Julie Hite | Pharmacist | 540 Seaboard Street, Myrtle Beach, SC 29577 | 2014-04-18 |
| Find all providers in zip 29577 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053754127 | Juan Faja-fernandez | Dentist | 107 Surgeons Drive, Myrtle Beach, SC 29579 | 2013-04-09 |
| 1376809772 | Ross Orthodontics LLC | Dentist | 3508 Caduceus Dr, Myrtle Beach, SC 29588-2902 | 2012-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194332619 | Candid South Carolina, P.C. | Dentist | 136-4 Forum Drive #a20, Columbia, SC 29229 | 2020-09-29 |
| 1518570902 | Foster Orthodontics, Pa | Dentist | 100 Hamlet Cir, Goose Creek, SC 29445-7111 | 2020-08-26 |
| 1740893122 | Foster Orthodontics, Pa | Dentist | 625 Skylark Dr, Charleston, SC 29407-5782 | 2020-08-26 |
| 1629602065 | Keith William Street | Dentist | 1460 John B White Sr Blvd Ste 1-5, Spartanburg, SC 29306-3996 | 2020-02-25 |
| 1225678931 | Rekha Wadhwa | Dentist | 100 Woodruff Place Cir, Simpsonville, SC 29681-3672 | 2020-01-10 |
| 1952965345 | Align America Sc, LLC | Dentist | 259 Textile Way Ste 103, Fort Mill, SC 29715-4550 | 2019-05-01 |
| 1952865289 | Orthodontic Specialists of Carolina, PC | Dentist | 611 Haywood Road, Greenville, SC 29607 | 2019-01-31 |
| 1699267021 | Trevan Samp | Dentist | 22 Westedge St Ste 106b, Charleston, SC 29403-6983 | 2018-06-01 |
| 1548759244 | Smile Doctors of South Carolina, P.C. | Dentist | 105 Ben Casey Dr Ste 109, Fort Mill, SC 29708-8557 | 2018-05-08 |
| 1386158541 | Katherine Dean Solomon | Dentist | 102 Buckwalter Pkwy Ste 3j, Bluffton, SC 29910-4130 | 2017-11-27 |
| Find all providers with the same taxonomy | ||||
| City | MYRTLE BEACH |
| Zip Code | 29577 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.