Kory Grahl, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

7695 Issued in NV

Practice address

1700 W Charleston Blvd BLDG D
Las Vegas, NV 89102-2335

Phone

(858) 382-2633

NPI assigned

Jun 14, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

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.

• Orthobar, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Las Vegas, NV
  • NPI 1033965991
  NPD Authorized official

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

{
    "created_epoch": "1497398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1174053078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12397 SHORELINE ECHO AVE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891386184"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 W CHARLESTON BLVD BLDG D",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891022335",
            "telephone_number": "858-382-2633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10755 Scripps Poway Pkwy Ste K",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921313924",
            "country_code": "US",
            "telephone_number": "858-547-0070",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "306 Walnut Ave Ste 36A",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921034936",
            "country_code": "US",
            "telephone_number": "619-234-8254",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "201 University Oaks Ste 770",
            "address_purpose": "LOCATION",
            "city": "Round Rock",
            "state": "TX",
            "postal_code": "786652443",
            "country_code": "US",
            "telephone_number": "512-537-5334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHL",
        "first_name": "KORY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-14",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "LL-548-21",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "101397",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "33969",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NV",
            "license": "7695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tanika Graham
• Tatynisha Graham
• Teyah Graham
• Tiffany Mari Graham
• Yoneke Leeandra Graham, CNA
• Troy Grahl
• Heather Grahlert
• Cynthia Deonne Grainger
• Jeanine Gramer
• William Roger Gramlich, MD

• Dentist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.