Active NPI
Kenneth Groshart II
- Dentist
- Memphis, TN
National Provider Identifier
1679067375
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 10779
- Practice address
- 6250 Poplar Ave
Memphis, TN 38119-4713 - Phone
- (901) 681-0011
- Fax
- (901) 681-9725
- NPI assigned
- Jun 18, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 10779 | TN | Primary |
Addresses
Primary practice location
6250 Poplar Ave
Memphis, TN 38119-4713
Mailing address
6250 Poplar Ave
Memphis, TN 38119-4713
Phone (901) 681-0011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10779 | TN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1529280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529280000000",
"number": "1679067375",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6250 POPLAR AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381194713",
"telephone_number": "901-681-0011",
"fax_number": "901-681-9725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6250 POPLAR AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381194713",
"telephone_number": "901-681-0011",
"fax_number": "901-681-9725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROSHART",
"first_name": "KENNETH",
"name_suffix": "II",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-06-18",
"last_updated": "2018-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "10779",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.