Individual provider Active NPI

John S Grant, D.D.S

  • General Practice Dentistry
  • Cudahy, WI
National Provider Identifier
1275507345
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5001334 Issued in WI
Practice address
6217 S Packard Ave
Cudahy, WI 53110-3096
Phone
(414) 764-5550
Fax
(414) 764-8175
NPI assigned
Feb 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 5001334 WI Primary

Addresses

Primary practice location

6217 S Packard Ave
Cudahy, WI 53110-3096

Mailing address

6217 S Packard Ave
Cudahy, WI 53110-3096
Phone (414) 764-5550

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20160209000386 WI Order and Referring Only - DentistPractitioner - Dentist 8729382999

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5001334WIMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1275507345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6217 S PACKARD AVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103096",
            "telephone_number": "414-764-5550",
            "fax_number": "414-764-8175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6217 S PACKARD AVE",
            "city": "CUDAHY",
            "state": "WI",
            "postal_code": "531103096",
            "telephone_number": "414-764-5550",
            "fax_number": "414-764-8175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANT",
        "first_name": "JOHN",
        "middle_name": "S",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "5001334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cudahy, WI

Sources for this page

Verify at the official NPI Registry.