NPIMap

Organization Active NPI

Granger Dental Group, LLC

  • General Practice Dentistry
  • Granger, IN
National Provider Identifier
1245688282
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
12011040A Issued in IN
Legal business name
GRANGER DENTAL GROUP, LLC
Practice address
6910 N Main St
BLDG 1, Unit 58
Granger, IN 46530-9680
Phone
(574) 277-4235
NPI assigned
Jun 1, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Dr. Joseph E Hickey III, DDSNPI 1710187422
Title
Dentist Owner
Phone
(574) 274-7778

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 12011040A IN Primary

Addresses

Primary practice location

6910 N Main St
BLDG 1, Unit 58
Granger, IN 46530-9680

Mailing address

6910 N Main St
BLDG 1, Unit 58
Granger, IN 46530-9680
Phone (574) 277-4235

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1245688282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6910 N MAIN ST",
            "address_2": "BLDG 1, UNIT 58",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309680",
            "telephone_number": "574-277-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6910 N MAIN ST",
            "address_2": "BLDG 1, UNIT 58",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465309680",
            "telephone_number": "574-277-4235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANGER DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "HICKEY",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "574-274-7778",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12011040A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Granger, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.