Individual provider Active NPI

Mark Grainer, DDS

  • General Practice Dentistry
  • Morganville, NJ
National Provider Identifier
1528160751
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
22DI01199900 Issued in NJ
Practice address
100 Campus Drive
Suite 202
Morganville, NJ 07751
Phone
(732) 972-2300
Fax
(732) 462-5752
NPI assigned
Sep 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 22DI01199900 NJ Primary

Addresses

Primary practice location

100 Campus Drive
Suite 202
Morganville, NJ 07751

Mailing address

100 Campus Drive
Suite 202
Morganville, NJ 07751
Phone (732) 972-2300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231212000730 NJ Order and Referring Only - DentistPractitioner - Dentist 7214251099

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22DI01199900NJMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Reuben Atlas DDS LLC General Practice 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.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528160751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 CAMPUS DRIVE",
            "address_2": "SUITE 202",
            "city": "MORGANVILLE",
            "state": "NJ",
            "postal_code": "07751",
            "telephone_number": "732-972-2300",
            "fax_number": "732-462-5752"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 CAMPUS DRIVE",
            "address_2": "SUITE 202",
            "city": "MORGANVILLE",
            "state": "NJ",
            "postal_code": "07751",
            "telephone_number": "732-972-2300",
            "fax_number": "732-462-5752"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAINER",
        "first_name": "MARK",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "22DI01199900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Morganville, NJ

Sources for this page

Verify at the official NPI Registry.