Stephen B Grandy, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D-4593 Issued in ID

Practice address

465 Memorial Drive
Pocatello, ID 83209-0000

Phone

(208) 282-3289

Fax

(208) 282-5834

NPI assigned

Jun 27, 2014

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

Medicare fee-for-service enrollment

Enrolled in WY

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Diamond G Dental LLC

  dba Diamond G Dental

  • General Practice Dentistry
  • Kemmerer, WY
  • NPI 1205291242
  NPD (past) Authorized official

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

{
    "created_epoch": "1403827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1407261407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090001",
            "telephone_number": "208-282-3289",
            "fax_number": "208-282-5834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "465 MEMORIAL DRIVE",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090000",
            "telephone_number": "208-282-3289",
            "fax_number": "208-282-5834"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDY",
        "first_name": "STEPHEN",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-27",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-4593",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Teresa L Goodwin, COTA
• Lauren Gorrebeeck
• Joseph Gorriceta
• Frederica A Gould, RPH
• Preston Graham
• Derek Shaune Grantham
• Julia Marie Graves
• Levi Graves
• Taura Graybill
• Desiree Greaves, PHARMD

• Dentist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Dentist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.