NPIMap

Individual provider Active NPI

Bradley David Degroote, D.D.S.

  • General Practice Dentistry
  • Florence, AL
National Provider Identifier
1093803967
Registry record updated Aug 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4562 Issued in AL
Practice address
1903 Bruin Dr
Florence, AL 35630-1461
Phone
(256) 767-3228
NPI assigned
Oct 10, 2006
Last updated
Aug 18, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 4562 AL Primary

Addresses

Primary practice location

1903 Bruin Dr
Florence, AL 35630-1461

Mailing address

1903 Bruin Dr
Florence, AL 35630-1461
Phone (256) 767-3228

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
4562ALMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Bradley Degroote D.D.S., LLC CurrentSince Jun 26, 2022 Accepting new patients

Locations

1903 Bruin Dr
Florence, AL 35630
Phone (256) 764-1858

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219017600000",
    "number": "1093803967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1903 BRUIN DR",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301461",
            "telephone_number": "256-767-3228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1903 BRUIN DR",
            "city": "FLORENCE",
            "state": "AL",
            "postal_code": "356301461",
            "telephone_number": "256-767-3228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEGROOTE",
        "first_name": "BRADLEY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-10",
        "last_updated": "2008-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AL",
            "license": "4562",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Florence, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 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.

Verify at the official NPI Registry.