Sergey Valerieyvich Gritsiv, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN013149 Issued in GA

Practice address

4038 Mundy Mill Rd
Oakwood, GA 30566-2518

Phone

(770) 534-4292

NPI assigned

Mar 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Oakwood Smiles PC

  • General Practice Dentistry
  • Oakwood, GA
  • NPI 1770724619
  NPD (past) Authorized official

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354838400000",
    "number": "1104893742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19",
            "city": "OAKWOOD",
            "state": "GA",
            "postal_code": "305660001",
            "telephone_number": "770-534-4292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4038 MUNDY MILL RD",
            "city": "OAKWOOD",
            "state": "GA",
            "postal_code": "305662518",
            "telephone_number": "770-534-4292"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRITSIV",
        "first_name": "SERGEY",
        "middle_name": "VALERIEYVICH",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2012-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN013149",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Olivia Gavala Gooden
• GPF Solutions LLC-Gigi'S Private Home Care
• Keith Grabowski, PA-C
• Alexander Graham, FNP-C
• Stephanie West Greene, DMD
• Hanmaum Senior Care LLC
• Lea Ann Hanson, PT, DPT
• Margaret Elaine Harkins, MBA
• Nichole Abernathy Hasan, PHARMD
• Katie Hawn, PT, DPT

• All providers in Oakwood, GA
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2012; 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.

Verify at the official NPI Registry.