Active NPI
Grayson Munn, DMD
- Dentist
- Prineville, OR
National Provider Identifier
1073294922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D11866
- Practice address
- 257 NE 2ND St
Prineville, OR 97754-1910 - Phone
- (541) 837-1709
- NPI assigned
- Jul 25, 2023
- Sex
- Male
- 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 | D11866 | OR | Primary |
Addresses
Primary practice location
257 NE 2ND St
Prineville, OR 97754-1910
Mailing address
2599 NE Yellowpine Rd
Prineville, OR 97754-9215
Phone (541) 704-8356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250610001167 | OR | Order and Referring Only - Dentist | 7911417852 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D11866 | OR | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1690243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690243200000",
"number": "1073294922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2599 NE YELLOWPINE RD",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977549215",
"telephone_number": "541-704-8356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "257 NE 2ND ST",
"city": "PRINEVILLE",
"state": "OR",
"postal_code": "977541910",
"telephone_number": "541-837-1709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MUNN",
"first_name": "GRAYSON",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-07-25",
"last_updated": "2023-07-25",
"certification_date": "2023-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OR",
"license": "D11866",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prineville, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.