NPIMap

Individual provider Active NPI

Grant F. Rodkey, DMD

  • General Practice Dentistry
  • Medical Lake, WA
National Provider Identifier
1174739452
Registry record updated Nov 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DE00008198 Issued in WA
Practice address
850 Maple Street
Eastern State Hospital
Medical Lake, WA 99022-0800
Phone
(509) 565-4000
Fax
(509) 565-4705
NPI assigned
May 15, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 23, 2016

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DE00008198 WA Primary
General Practice Dentistry 1223G0001X D3337 ID
General Practice Dentistry 1223G0001X D7434 OR

Addresses

Primary practice location

850 Maple Street
Eastern State Hospital
Medical Lake, WA 99022-0800

Mailing address

PO Box 800
Eastern State Hospital
Medical Lake, WA 99022-0800
Phone (509) 565-4000

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)
Enrolled

State licenses

LicenseStateTypeSpecialty
D3337IDMDGeneral Practice Dentistry
D7434ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
John L Turner DMD PLLC Past Accepting new patients
Department of Social Past Accepting new patients
Eastern State Hospital Pharmacy PastSince Oct 19, 2016 Accepting new patients

Organizations & group practices 3

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": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1479859200000",
    "number": "1174739452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800",
            "address_2": "EASTERN STATE HOSPITAL",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 MAPLE STREET",
            "address_2": "EASTERN STATE HOSPITAL",
            "city": "MEDICAL LAKE",
            "state": "WA",
            "postal_code": "990220800",
            "telephone_number": "509-565-4000",
            "fax_number": "509-565-4705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODKEY",
        "first_name": "GRANT",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-15",
        "last_updated": "2016-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE00008198",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3337",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7434",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Medical Lake, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2016; 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.