Thomas Grandville, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

056816 Issued in NY

Practice address

8 Medical Dr
Port Jefferson Station, NY 11776-1601

Phone

(631) 928-8585

NPI assigned

Jun 9, 2011

Last updated

Apr 19, 2017By the provider in NPPES

Sex

Male

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

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Coniglio Dental PC

  dba Suffolk Pediatric Dentistry PC

  • Pediatric Dentistry
  • Port Jefferson Station, NY
  • NPI 1609915883
  NPD (past)
• Suffolk Pediatric Dentistry

  • Pediatric Dentistry
  • Port Jefferson Station, NY
  • NPI 1598997900
  NPD (past)

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

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492560000000",
    "number": "1487949236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8 MEDICAL DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761601",
            "telephone_number": "631-928-8585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8 MEDICAL DR",
            "city": "PORT JEFFERSON STATION",
            "state": "NY",
            "postal_code": "117761601",
            "telephone_number": "631-928-8585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANDVILLE",
        "first_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-06-09",
        "last_updated": "2017-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NY",
            "license": "056816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesenia Gonzalez
• Nithya Gopal, M.D.
• Dinamarie Gordon, R.N.
• Kinjal Amit Gosalia, STUDENT
• Daniel Gottfried, APRN, FNP
• Iris Ann Granek, M.D.
• Arron Jordan Gravina
• Katherine McCauley Graziano, OTR/L, PT, DPT, CLT
• Keriann Marie Greehy, LPN
• Karen Greenwood, M.S.W.

• Pediatric Dentistry in Port Jefferson Station, NY
• Providers in Port Jefferson Station, NY by specialty
• Pediatric Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2017; 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.