Kent W. Gragg, D.D.S.

Key facts

NPI

1639388697

Entity type

Individual (NPI type 1)

Primary specialty

Periodontics 1223P0300X

License

6265 (IA)

Practice address

237 West Mulberry
Ogden, IA 50212-0813

Phone

(515) 275-2250

Fax

(515) 275-2816

NPI assigned

May 22, 2007

Sex

Male

Sole proprietor

No

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.

• Ogden Family Dental PLC Dentist · Ogden, IA · NPI 1528145976
  NPD (past)

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Practice roles

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1639388697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "422 OLYMPIC DR",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507014972",
            "telephone_number": "319-232-6239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "237 WEST MULBERRY",
            "city": "OGDEN",
            "state": "IA",
            "postal_code": "502120813",
            "telephone_number": "515-275-2250",
            "fax_number": "515-275-2816"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAGG",
        "first_name": "KENT",
        "middle_name": "W.",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "IA",
            "license": "6265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Ogden, IA · Periodontics in Iowa