Nathan Alphonso Graddy, D.D.S

Primary specialty

DentistTaxonomy code 122300000X

License

DN4964 Issued in FL

Practice address

9721 US Highway 19
Port Richey, FL 34668-7503

Phone

(727) 846-7555

NPI assigned

Aug 24, 2011

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

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

Locations

Networks

• Freedom Health HMO Network

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.

• Family Dental Group Inc

  • General Practice Dentistry
  • Tampa, FL
  • NPI 1790825289
  NPD Authorized official
• Economy Dentures of Hudson LLC

  • General Practice Dentistry
  • Hudson, FL
  • NPI 1487897575
  NPD

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1225318025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 82969",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336822969",
            "telephone_number": "813-866-0930",
            "fax_number": "813-405-3722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9721 US HIGHWAY 19",
            "city": "PORT RICHEY",
            "state": "FL",
            "postal_code": "346687503",
            "telephone_number": "727-846-7555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2727 W Dr Martin Luther King Jr Blvd",
            "address_2": "Suite 120",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336076383",
            "country_code": "US",
            "telephone_number": "813-221-0010",
            "fax_number": "813-221-0111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRADDY",
        "first_name": "NATHAN",
        "middle_name": "ALPHONSO",
        "name_prefix": "Dr.",
        "credential": "D.D.S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-08-24",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN4964",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "072704100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Goodwin, MS
• Derek Gorgas
• Goshen House Residential
• Caryn Gottlieb, LMHC
• Rajiv Goyal, MD
• Tanisha Nicole Grant
• Adam Scott Greenfield, DO
• Kim Lavell Grieder
• Bryan N Griffith, D.M.D.
• Scott R Griffith, DMD

• Dentist in Port Richey, FL
• Providers in Port Richey, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; 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.