Jack Gradoville, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS-10008 Issued in IA

Practice address

827 S Highland St
Williamsburg, IA 52361-9333

Phone

(319) 668-9808

NPI assigned

Jun 20, 2022

Last updated

Jun 20, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Williamsburg Dental Health Clinic Inc

  • General Practice Dentistry
  • Williamsburg, IA
  • NPI 1336552678
  NPD
• Williamsburg Dental Health Clinic Inc

  • Customized Equipment (DME)
  • Williamsburg, IA
  • NPI 1841836251
  NPD

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

{
    "created_epoch": "1655683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655683200000",
    "number": "1326779588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 GREENWOOD DR",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522462124",
            "telephone_number": "515-664-0180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "827 S HIGHLAND ST",
            "city": "WILLIAMSBURG",
            "state": "IA",
            "postal_code": "523619333",
            "telephone_number": "319-668-9808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADOVILLE",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-20",
        "last_updated": "2022-06-20",
        "certification_date": "2022-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "DDS-10008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE NUMBER",
            "identifier": "DDS-10008",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joel Christopher Carr, D.C.
• Stacy Darnold, LPT
• Amanda K Deaner, PHARMD
• Mary J Dejarnatt, D.C,
• Kristina Gingerich
• Megan Lynn Grier, DDS
• Ariane Ishimwe Hakizimana
• Hartig Drug Co Corp (Hartig Drug Co #27)
• Jacie Ann Henderson, PHARMD
• Highland Ridge Care Center, LLC

• General Practice Dentistry in Williamsburg, IA
• Providers in Williamsburg, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2022; 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.