Active NPI
Gary F Grilli, D.M.D
- Dentist
- South Windsor, CT
National Provider Identifier
1114094299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8914
- Practice address
- 435 Buckland Rd
Medical Arts Building
South Windsor, CT 06074-3720 - Phone
- (860) 644-1509
- Fax
- (860) 644-1500
- NPI assigned
- Nov 30, 2006
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 8914 | CT | Primary |
Addresses
Primary practice location
435 Buckland Rd
Medical Arts Building
South Windsor, CT 06074-3720
Mailing address
80 Berle Rd
South Windsor, CT 06074-1522
Phone (860) 644-1509
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 |
|---|---|---|---|
| 8914 | CT | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1114094299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "80 BERLE RD",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060741522",
"telephone_number": "860-644-1509",
"fax_number": "860-644-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "435 BUCKLAND RD",
"address_2": "MEDICAL ARTS BUILDING",
"city": "SOUTH WINDSOR",
"state": "CT",
"postal_code": "060743720",
"telephone_number": "860-644-1509",
"fax_number": "860-644-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRILLI",
"first_name": "GARY",
"middle_name": "F",
"name_prefix": "Dr.",
"credential": "D.M.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CT",
"license": "8914",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Windsor, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.