Active NPI
Susanne T Grennell, D.D.S.
- Dentist
- Pleasant Valley, NY
National Provider Identifier
1013189711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 34188
- Practice address
- 2755 Route 82
Pleasant Valley, NY 12569-5009 - Phone
- (845) 677-0313
- Fax
- (845) 677-1095
- NPI assigned
- Apr 2, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 34188 | NY | Primary |
Addresses
Primary practice location
2755 Route 82
Pleasant Valley, NY 12569-5009
Mailing address
PO Box 153
Billings, NY 12510-0153
Phone (845) 677-0313
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
| License | State | Type | Specialty |
|---|---|---|---|
| 34188 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207094400000",
"number": "1013189711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 153",
"city": "BILLINGS",
"state": "NY",
"postal_code": "125100153",
"telephone_number": "845-677-0313",
"fax_number": "845-677-1095"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2755 ROUTE 82",
"city": "PLEASANT VALLEY",
"state": "NY",
"postal_code": "125695009",
"telephone_number": "845-677-0313",
"fax_number": "845-677-1095"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRENNELL",
"first_name": "SUSANNE",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-04-02",
"last_updated": "2008-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "34188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pleasant Valley, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.