Active NPI
Graden Trumble, DDS, MS
- Orthodontics and Dentofacial Orthopedics Dentistry
- Fayetteville, NC
National Provider Identifier
1255960399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 12157
- Practice address
- 2029 Valleygate Dr Ste 201
Fayetteville, NC 28304-3772 - Phone
- (910) 885-2451
- NPI assigned
- Apr 1, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1504 | WY | |
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 12157 | NC | Primary |
Addresses
Primary practice location
2029 Valleygate Dr Ste 201
Fayetteville, NC 28304-3772
Mailing address
2035 E Teton Blvd
Green River, WY 82935-6237
Phone (307) 871-5413
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1504 | Other | WY | WYOMING DENTAL LICENSE |
| 12157 | Other | NC | NORTH CAROLINA DENTAL LICENSE |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | graden-trumble@ouhsc.edu |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1504 | WY | MD | General Practice Dentistry |
| 12157 | NC | MD | Orthodontics and Dentofacial Orthopedic Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1585699200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637625600000",
"number": "1255960399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2035 E TETON BLVD",
"city": "GREEN RIVER",
"state": "WY",
"postal_code": "829356237",
"telephone_number": "307-871-5413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2029 VALLEYGATE DR STE 201",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283043772",
"telephone_number": "910-885-2451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUMBLE",
"first_name": "GRADEN",
"name_prefix": "Dr.",
"credential": "DDS, MS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-04-01",
"last_updated": "2021-11-23",
"certification_date": "2021-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WY",
"license": "1504",
"primary": false
},
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "NC",
"license": "12157",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WYOMING DENTAL LICENSE",
"identifier": "1504",
"state": "WY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH CAROLINA DENTAL LICENSE",
"identifier": "12157",
"state": "NC"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "graden-trumble@ouhsc.edu",
"affiliation": "N",
"address_1": "1201 N Stonewall Ave Rm 452",
"city": "Oklahoma City",
"state": "OK",
"country_code": "US",
"postal_code": "731171214",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.