Active NPI
Dennis Lee Granberry, DDS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Hattiesburg, MS
National Provider Identifier
1124248240
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 136269
- Practice address
- #9 Professional Parkway
Hattiesburg, MS 39402 - Phone
- (601) 264-2200
- Fax
- (601) 268-6068
- NPI assigned
- Apr 30, 2007
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 136269 | MS | Primary |
Addresses
Primary practice location
#9 Professional Parkway
Hattiesburg, MS 39402
Mailing address
#9 Professional Parkway
Hattiesburg, MS 39402
Phone (601) 264-2200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00660123 | Medicaid | MS |
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 |
|---|---|---|---|
| 136269 | MS | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124248240",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "#9 PROFESSIONAL PARKWAY",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "39402",
"telephone_number": "601-264-2200",
"fax_number": "601-268-6068"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "#9 PROFESSIONAL PARKWAY",
"city": "HATTIESBURG",
"state": "MS",
"postal_code": "39402",
"telephone_number": "601-264-2200",
"fax_number": "601-268-6068"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANBERRY",
"first_name": "DENNIS",
"middle_name": "LEE",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-04-30",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "MS",
"license": "136269",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00660123",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hattiesburg, MS
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.