Grant Thomas King, D.D.S., M.D.S.

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DS0000010322 Issued in TN

Practice address

6268 Poplar Ave
Memphis, TN 38119-4713

Phone

(901) 761-3770

NPI assigned

Jun 14, 2016

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

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.

Opted out of Medicare

Yes, effective Sep 17, 2020 through Sep 17, 2026

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 and National Provider Directory roles.

• Periodontal Associates of Memphis

  • Periodontics
  • Memphis, TN
  • NPI 1023158185
  NPD (past)

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

{
    "created_epoch": "1465862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562630400000",
    "number": "1619327244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6268 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194713",
            "telephone_number": "901-761-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6268 POPLAR AVE",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381194713",
            "telephone_number": "901-761-3770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "University Of Tennessee Health Science Ctr",
            "address_2": "920 Madison Ave, Suite 447",
            "address_purpose": "LOCATION",
            "city": "Memphis",
            "state": "TN",
            "postal_code": "381630001",
            "country_code": "US",
            "telephone_number": "901-448-6920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KING",
        "first_name": "GRANT",
        "middle_name": "THOMAS",
        "name_prefix": "Dr.",
        "credential": "D.D.S., M.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-14",
        "last_updated": "2019-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "TN",
            "license": "DS0000010322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• D Katrina Mitchell King, FNP
• Danielle Ranae King, PSY.D.
• Demetria L King
• Dewitt H King, D.D.S.
• Dewonia Lanishe King, MSN
• Helen Ruth King
• Jacqueline Yvonne King
• Jason M. King, B.A.
• Jennifer King, NP-C
• Jimmy R. King, BSW

• Periodontics in Memphis, TN
• Providers in Memphis, TN by specialty
• Periodontics in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.