Jerry D Gragg DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2473 Issued in WI

Legal business name

JERRY D GRAGG DDS

Practice address

3489 N 76TH St
Milwaukee, WI 53222-3968

Phone

(414) 445-4111

Fax

(414) 445-4103

NPI assigned

Aug 17, 2010

Organization subpart

No

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

Authorized official

Name

Linda McDermott

Title

Office Manager

Phone

(414) 445-4111

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1282003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282003200000",
    "number": "1548575335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3489 N 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532223968",
            "telephone_number": "414-445-4111",
            "fax_number": "414-445-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3489 N 76TH ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532223968",
            "telephone_number": "414-445-4111",
            "fax_number": "414-445-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JERRY D GRAGG DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-17",
        "last_updated": "2010-08-17",
        "status": "A",
        "authorized_official_last_name": "MCDERMOTT",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "414-445-4111"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": "2473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33408000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Dentist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2010; 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.