Individual provider Active NPI

Michael R Gradeless, D.D.S.

  • General Practice Dentistry
  • Fishers, IN
National Provider Identifier
1316976863
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
7941 Issued in IN
Practice address
10100 Lantern Rd
Fishers, IN 46037-9651
Phone
(317) 841-3130
Fax
(317) 841-3007
NPI assigned
Jun 30, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 7941 IN Primary

Addresses

Primary practice location

10100 Lantern Rd
Fishers, IN 46037-9651

Mailing address

10100 Lantern Rd
Fishers, IN 46037-9686
Phone (317) 841-3130

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20161122001943 IN Order and Referring Only - DentistPractitioner - Dentist 9032498688

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7941INMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1316976863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10100 LANTERN RD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379686",
            "telephone_number": "317-841-3130",
            "fax_number": "317-841-3007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10100 LANTERN RD",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460379651",
            "telephone_number": "317-841-3130",
            "fax_number": "317-841-3007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADELESS",
        "first_name": "MICHAEL",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "7941",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fishers, IN

Sources for this page

Verify at the official NPI Registry.