Individual provider Active NPI

Robert Wayne Grodner, D.D.S.

  • General Practice Dentistry
  • Houston, TX
National Provider Identifier
1013012483
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
36760 Issued in TX
Practice address
3701 Kirby Dr Ste 550
Houston, TX 77098-3926
Phone
(713) 490-8400
NPI assigned
Sep 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 1116 NM
General Practice Dentistry 1223G0001X 36760 TX Primary

Addresses

Primary practice location

3701 Kirby Dr Ste 550
Houston, TX 77098-3926

Mailing address

10207 Willowgrove Dr
Houston, TX 77035-3421
Phone (505) 363-9215

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
1116NMMDGeneral Practice Dentistry
36760TXMDPharmacist

NPI Registry JSON

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632268800000",
    "number": "1013012483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10207 WILLOWGROVE DR",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770353421",
            "telephone_number": "505-363-9215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 KIRBY DR STE 550",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770983926",
            "telephone_number": "713-490-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRODNER",
        "first_name": "ROBERT",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NM",
            "license": "1116",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "36760",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; 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.