Graysen McConnell Bloom, DDS

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

12058 Issued in TN

Practice address

1858 Crest Rd
Maryville, TN 37804-4305

Phone

(865) 977-7110

NPI assigned

Mar 24, 2022

Sex

Female

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 TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1648080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786752000000",
    "number": "1447900402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1858 CREST RD",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378044305",
            "telephone_number": "865-977-7110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1858 CREST RD",
            "city": "MARYVILLE",
            "state": "TN",
            "postal_code": "378044305",
            "telephone_number": "865-977-7110"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11548 Chapman Hwy",
            "address_purpose": "LOCATION",
            "city": "Seymour",
            "state": "TN",
            "postal_code": "378655044",
            "country_code": "US",
            "telephone_number": "865-577-7800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7761 Dannaher Dr",
            "address_purpose": "LOCATION",
            "city": "Powell",
            "state": "TN",
            "postal_code": "378494049",
            "country_code": "US",
            "telephone_number": "865-947-9800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "550 Town Creek Rd E Ste 102",
            "address_purpose": "LOCATION",
            "city": "Lenoir City",
            "state": "TN",
            "postal_code": "377722600",
            "country_code": "US",
            "telephone_number": "865-986-4582",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "130 Mabry Hood Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379222221",
            "country_code": "US",
            "telephone_number": "865-693-4442",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLOOM",
        "first_name": "GRAYSEN",
        "middle_name": "MCCONNELL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-03-24",
        "last_updated": "2026-08-15",
        "certification_date": "2026-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TN",
            "license": "12058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Maryville, TN
• Providers in Maryville, TN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2026; 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.