Tara Lynn Grzetic, DMD, MS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

0000011264 Issued in TN

Practice address

2055 Foxfield Rd
St Charles, IL 60174-1442

Phone

(630) 584-6555

NPI assigned

Jul 22, 2020

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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.

• Myorthos Illinois Orthodontics PC

  dba Prose Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • St Charles, IL
  • NPI 1811778715
  NPD
• Myorthos Illinois Orthodontics PC

  dba Premier Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Ottawa, IL
  • NPI 1194454454
  NPD (past)
• Myorthos Illinois Orthodontics PC

  dba Pasha Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Aurora, IL
  • NPI 1780452003
  NPD (past)
• Professional Dental Alliance of Crossville, PLLC

  dba Snodgrass-King Dental Associates

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Franklin, TN
  • NPI 1720968639
  NPD (past)
• Professional Dental Alliance of Tennessee, PLLC

  • Pediatric Dentistry
  • Franklin, TN
  • NPI 1669530291
  NPD (past)

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

{
    "created_epoch": "1595376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673395200000",
    "number": "1467060897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 N OLD WORLD 3RD ST APT 807",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032245",
            "telephone_number": "630-715-3377"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2055 FOXFIELD RD",
            "city": "ST CHARLES",
            "state": "IL",
            "postal_code": "601741442",
            "telephone_number": "630-584-6555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2050 Marquette Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Peru",
            "state": "IL",
            "postal_code": "613544000",
            "country_code": "US",
            "telephone_number": "815-224-2355",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4827 S Route 59 Ste 115",
            "address_purpose": "LOCATION",
            "city": "Naperville",
            "state": "IL",
            "postal_code": "605648318",
            "country_code": "US",
            "telephone_number": "630-527-6000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRZETIC",
        "first_name": "TARA",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DMD, MS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-22",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "TN",
            "license": "0000011264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Growing Awareness Counseling
• Growing Through Life Therapy LLC
• Growing Wellness LLC (Growing Wellness)
• Elijah Grundman, RBT
• Jonathon M Gruszeczki, LCPC
• Ana Isabel Grzybek, MHS, CCC-SLP/L
• Elaine Marie Gudeman, RN
• Katherine M Guenther
• Michael J Guidotti, M.S., CCC-SLP/L
• Wyatt Gundlach, RBT

• Orthodontics and Dentofacial Orthopedics Dentistry in St Charles, IL
• Providers in St Charles, IL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; 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.