JRL Dental Dba Grace Dental Care

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

JRL DENTAL DBA GRACE DENTAL CARE

Practice address

15081 Maccorkle Ave
Chelyan, WV 25035

Phone

(304) 595-3551

Fax

(304) 595-6822

NPI assigned

Aug 13, 2019

Last updated

Aug 13, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jason R Long, DDS

Title

Owner

Phone

(304) 784-6665

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1565654400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1043866338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1628 W 3RD AVE",
            "city": "WILLIAMSON",
            "state": "WV",
            "postal_code": "256613007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15081 MACCORKLE AVE",
            "city": "CHELYAN",
            "state": "WV",
            "postal_code": "25035",
            "telephone_number": "304-595-3551",
            "fax_number": "304-595-6822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JRL DENTAL DBA GRACE DENTAL CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-08-13",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-784-6665",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tina Marie Daniels, PRSS
• Dr. Ronald a. Grace, DDS PLLC (Grace Dental Care)
• Ronald Alan Grace, DDS
• Whitney Brooke Sisler, BS

• General Practice Dentistry in Chelyan, WV
• Providers in Chelyan, WV by specialty
• General Practice Dentistry in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; 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.