Active NPI
Brandon Lee Greenwalt, DMD
- Dentist
- Gainesville, FL
National Provider Identifier
1194087742
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN 19737
- Practice address
- 410 NE Waldo Rd
Gainesville, FL 32641-5685 - Phone
- (352) 375-3790
- Fax
- (352) 375-3791
- NPI assigned
- Jun 11, 2012
- 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 | DN 19737 | FL | Primary |
Addresses
Primary practice location
410 NE Waldo Rd
Gainesville, FL 32641-5685
Mailing address
1302 River St
Palatka, FL 32177-5042
Phone (386) 328-8371
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 |
|---|---|---|---|
| DN 19737 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339372800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1383004800000",
"number": "1194087742",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1302 RIVER ST",
"city": "PALATKA",
"state": "FL",
"postal_code": "321775042",
"telephone_number": "386-328-8371",
"fax_number": "386-328-1519"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "410 NE WALDO RD",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "326415685",
"telephone_number": "352-375-3790",
"fax_number": "352-375-3791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENWALT",
"first_name": "BRANDON",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-11",
"last_updated": "2013-10-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN 19737",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.