Active NPI
Gregory Leonard Koontz, DMD
- Periodontics
- Oceanside, CA
National Provider Identifier
1417064437
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 0401411550
- Practice address
- 200 Mercy Circle
Oceanside, CA 92055 - Phone
- (757) 300-6695
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 28850 | TX | |
| Periodontics | 1223P0300X | 0401411550 | VA | Primary |
Addresses
Primary practice location
200 Mercy Circle
Oceanside, CA 92055
Mailing address
11612 Milbern Dr
Potomac, MD 20854-3522
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28850 | TX | MD | Periodontist |
| 0401411550 | VA | MD | Periodontist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720742400000",
"number": "1417064437",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11612 MILBERN DR",
"city": "POTOMAC",
"state": "MD",
"postal_code": "208543522"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 MERCY CIRCLE",
"city": "OCEANSIDE",
"state": "CA",
"postal_code": "92055",
"telephone_number": "757-300-6695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOONTZ",
"first_name": "GREGORY",
"middle_name": "LEONARD",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2024-07-12",
"certification_date": "2024-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "TX",
"license": "28850",
"primary": false
},
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "VA",
"license": "0401411550",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oceanside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.