Active NPI
William Gordon Grooms, DDS
- Dentist
- Granville, OH
National Provider Identifier
1487228656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 13593
- Practice address
- 121 Broadway E
Granville, OH 43023-1303 - Phone
- (703) 868-4987
- NPI assigned
- May 13, 2021
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 13593 | NC | Primary |
| Dentist | 122300000X | 30.026478 | OH |
Addresses
Primary practice location
121 Broadway E
Granville, OH 43023-1303
Mailing address
55 East 9TH Ave Apt 323
Columbus, OH 43201
Phone (703) 868-4987
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 |
|---|---|---|---|
| 30.026478 | OH | MD | Dentist |
| 13593 | NC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620864000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1730678400000",
"number": "1487228656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 EAST 9TH AVE APT 323",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "43201",
"telephone_number": "703-868-4987"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "121 BROADWAY E",
"city": "GRANVILLE",
"state": "OH",
"postal_code": "430231303",
"telephone_number": "703-868-4987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROOMS",
"first_name": "WILLIAM",
"middle_name": "GORDON",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-05-13",
"last_updated": "2024-11-04",
"certification_date": "2024-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "13593",
"primary": true
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30.026478",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Granville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 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.