Jill Grannis, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30347 Issued in CA

Practice address

530 Moorpark Ave
Suite 140
Moorpark, CA 93021-1861

Phone

(805) 529-5955

Fax

(805) 529-9595

NPI assigned

Sep 17, 2008

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.

State licenses

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352764800000",
    "number": "1386893113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "530 MOORPARK AVE",
            "address_2": "SUITE 140",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930211861",
            "telephone_number": "805-529-5955",
            "fax_number": "805-529-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 MOORPARK AVE",
            "address_2": "SUITE 140",
            "city": "MOORPARK",
            "state": "CA",
            "postal_code": "930211861",
            "telephone_number": "805-529-5955",
            "fax_number": "805-529-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANNIS",
        "first_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-17",
        "last_updated": "2012-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30347",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Golden State Providers, a Medical Corporation
• Herbert Harold Goldin, MD
• Samantha Gomberg
• Brenda Gonzalez
• Lauren Gonzalez, WHNP-BC
• Genesis Guillen
• Amelia Faith Gutierrez
• Ryan Haddock, PTLA
• James Handal, PTA
• Maritza Carolina Handal

• General Practice Dentistry in Moorpark, CA
• Providers in Moorpark, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; 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.