William Arthur Grosdidier

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D13681 Issued in MN

Practice address

1100 Wilford Hall Loop BLDG 4554
Jbsa Lackland, TX 78236-5638

Phone

(651) 468-9356

NPI assigned

May 3, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

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

Specialty

Oral Surgery

Education

University of Minnesota School of Dentistry, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Oral and Maxillofacial Surgery Asso of Eau Claire SCGroup PAC ID 1456355643, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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 and National Provider Directory roles.

• Oral and Maxillofacial Surgery Asso of Eau Claire SC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Altoona, WI
  • NPI 1316954928

  Oral and Maxillofacial Surgery

  Medicare reassignment Care Compare group NPD
• Advanced Endodontics, SC

  • Endodontics
  • Altoona, WI
  • NPI 1437971470
  NPD

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

{
    "created_epoch": "1462233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1447605886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP BLDG 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 WILFORD HALL LOOP BLDG 4554",
            "city": "JBSA LACKLAND",
            "state": "TX",
            "postal_code": "782365638",
            "telephone_number": "651-468-9356"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3551 Roger Brooke Dr",
            "address_purpose": "LOCATION",
            "city": "Fort Sam Houston",
            "state": "TX",
            "postal_code": "782344504",
            "country_code": "US",
            "telephone_number": "651-468-9356",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROSDIDIER",
        "first_name": "WILLIAM",
        "middle_name": "ARTHUR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-03",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13681",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D13681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Palmira R Granado, LCSW
• Jay Douglas Graver, DMD
• Abigail Greenwell, MD
• Jerry George Greeson, MED, LAT, ATC
• Bryce M Griffin, DPT
• Jordan Grove, MD
• Mary Teju Guest, M.D.
• Daniel K Gullekson, OD
• Alejandra Vraanica Gutierrez
• Melissa Erin Gutierrez

• Oral and Maxillofacial Surgery (Dentist) in Jbsa Lackland, TX
• Providers in Jbsa Lackland, TX by specialty
• Oral and Maxillofacial Surgery (Dentist) in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.