Individual provider Active NPI

Alan Mitchell Gross, D.D.S.

  • General Practice Dentistry
  • Fort Worth, TX
National Provider Identifier
1366435992
Registry record updated Nov 16, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
15561 Issued in TX
Practice address
3317 Phoenix Dr
Fort Worth, TX 76116-6307
Phone
(817) 244-1700
NPI assigned
Aug 30, 2005
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 16, 2011

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 15561 TX Primary

Addresses

Primary practice location

3317 Phoenix Dr
Fort Worth, TX 76116-6307

Mailing address

3317 Phoenix Dr
Fort Worth, TX 76116-6307
Phone (817) 244-1700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20150409001065 TX Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 9830417567

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

NPI Registry JSON

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

{
    "created_epoch": "1125360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321401600000",
    "number": "1366435992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3317 PHOENIX DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761166307",
            "telephone_number": "817-244-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3317 PHOENIX DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761166307",
            "telephone_number": "817-244-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSS",
        "first_name": "ALAN",
        "middle_name": "MITCHELL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-08-30",
        "last_updated": "2011-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "15561",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.