Active NPI
Matthew John Gramkee, DDS
- Periodontics
- Reston, VA
National Provider Identifier
1487679338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 042692-1
- Practice address
- 11503 Sunrise Valley Dr
Reston, VA 20191-1505 - Phone
- (703) 860-3200
- NPI assigned
- Jul 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 042692-1 | NY | Primary |
Addresses
Primary practice location
11503 Sunrise Valley Dr
Reston, VA 20191-1505
Mailing address
8901 Wisconsin Ave
Department of Periodontics
Bethesda, MD 20817
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 |
|---|---|---|---|
| 042692-1 | NY | MD | Periodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Reston Dental Group, PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Dental Clinic/Center
- Reston, VA
- NPI 1427128669
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1446508800000",
"number": "1487679338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8901 WISCONSIN AVE",
"address_2": "DEPARTMENT OF PERIODONTICS",
"city": "BETHESDA",
"state": "MD",
"postal_code": "20817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11503 SUNRISE VALLEY DR",
"city": "RESTON",
"state": "VA",
"postal_code": "201911505",
"telephone_number": "703-860-3200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAMKEE",
"first_name": "MATTHEW",
"middle_name": "JOHN",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2015-11-03",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NY",
"license": "042692-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Reston, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.