Active NPI
Jon James Gruchalski, DDS
- General Practice Dentistry
- New Berlin, WI
National Provider Identifier
1083873004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3978
- Practice address
- 4010 South Church Drive
New Berlin, WI 53151 - Phone
- (262) 784-2449
- Fax
- (262) 784-7873
- NPI assigned
- Jun 5, 2008
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3978 | WI | Primary |
Addresses
Primary practice location
4010 South Church Drive
New Berlin, WI 53151
Mailing address
4010 South Church Drive
New Berlin, WI 53151
Phone (262) 784-2449
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 |
|---|---|---|---|
| 3978 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212624000000",
"number": "1083873004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4010 SOUTH CHURCH DRIVE",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "53151",
"telephone_number": "262-784-2449",
"fax_number": "262-784-7873"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4010 SOUTH CHURCH DRIVE",
"city": "NEW BERLIN",
"state": "WI",
"postal_code": "53151",
"telephone_number": "262-784-2449",
"fax_number": "262-784-7873"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUCHALSKI",
"first_name": "JON",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-06-05",
"last_updated": "2008-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "3978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New Berlin, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.