Park City Dental, PC

Primary specialty

DentistTaxonomy code 122300000X

License

019026609 Issued in IL

Legal business name

PARK CITY DENTAL, PC

Practice address

555 N Court St
Suite 100
Rockford, IL 61103-6862

Phone

(815) 708-6556

Fax

(815) 708-6477

NPI assigned

Dec 11, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Jason M Grinter, DDSNPI 1255401899

Title

President

Phone

(815) 708-6556

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jason Michael Grinter, DDS

  • Dentist
  • Rockford, IL
  • NPI 1255401899
  NPD (past) Authorized official

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

{
    "created_epoch": "1386720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386720000000",
    "number": "1225469596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N COURT ST",
            "address_2": "SUITE 100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036862",
            "telephone_number": "815-708-6556",
            "fax_number": "815-708-6477"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N COURT ST",
            "address_2": "SUITE 100",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611036862",
            "telephone_number": "815-708-6556",
            "fax_number": "815-708-6477"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARK CITY DENTAL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-11",
        "last_updated": "2013-12-11",
        "status": "A",
        "authorized_official_last_name": "GRINTER",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-708-6556",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IL",
            "license": "019026609",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "091906609",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Papoccia
• Zayd Parekh, DO
• Felicia Michelle Parham, LCPC
• Kathleen E Parilla, PA-C
• Linda Ann Parish, R.N. N.P.
• Geonwoong Park, DDS
• Peter K Park, MD
• Samuel Park, MD
• Gregory K Parker, LCPC
• Jazmin L Parker, PA-C

• Dentist in Rockford, IL
• Providers in Rockford, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 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.

Verify at the official NPI Registry.