Gordon Ernest Gruen, D.D.S.

Primary specialty

Oral and Maxillofacial Pathology DentistryTaxonomy code 1223P0106X

License

DS 1783 Issued in TN

Practice address

780 Ridge Lake Blvd
Suite 101
Memphis, TN 38120-9426

Phone

(901) 682-8431

Fax

(901) 682-2345

NPI assigned

Aug 21, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

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

Medicare enrollment (NPD)

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.

• Bluff City Oral Surgery & Associates, LLC

  • Dental Clinic/Center
  • Memphis, TN
  • NPI 1902569601
  NPD (past)

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629183116",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "780 RIDGE LAKE BLVD",
            "address_2": "SUITE 101",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209426",
            "telephone_number": "901-682-8431",
            "fax_number": "901-682-2345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "780 RIDGE LAKE BLVD",
            "address_2": "SUITE 101",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381209426",
            "telephone_number": "901-682-8431",
            "fax_number": "901-682-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRUEN",
        "first_name": "GORDON",
        "middle_name": "ERNEST",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0106X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Pathology",
            "state": "TN",
            "license": "DS 1783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "2007914",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Candace Grove, LMSW
• Gary Grover, ACNP
• Danielle Groves, CRNP
• Katrina Mae Grubb, O.T.
• Erika Gruber, PHARMD
• Alexis Grycko, OD
• Michelle Elise Grzybowski, PT, DPT
• Guardian Care of TN Homecare
• Ross Phillip Guastella, R.PH.
• Cassidy Gubin, CRNA

• Oral and Maxillofacial Pathology Dentistry in Memphis, TN
• Providers in Memphis, TN by specialty
• Oral and Maxillofacial Pathology Dentistry in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.