Heatherly Henson Grissom, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

3228-02 Issued in MS

Practice address

1896 Main St
Suite B
Madison, MS 39110-7676

Phone

(601) 898-9390

Fax

(601) 898-9395

NPI assigned

Aug 18, 2008

Sex

Female

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

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.

• Dental Care of Madison

  • General Practice Dentistry
  • Madison, MS
  • NPI 1821137316
  NPD (past)

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219017600000",
    "number": "1699921965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1896 MAIN ST",
            "address_2": "SUITE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107676",
            "telephone_number": "601-898-9390",
            "fax_number": "601-898-9395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1896 MAIN ST",
            "address_2": "SUITE B",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107676",
            "telephone_number": "601-898-9390",
            "fax_number": "601-898-9395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISSOM",
        "first_name": "HEATHERLY",
        "middle_name": "HENSON",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-18",
        "last_updated": "2008-08-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MS",
            "license": "3228-02",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Breckin Skye Gray, FNP
• David Green, M.D.
• Michael Greene, DO
• Stephen Charles Greer II DMD, D.M.D
• Claire Dornbusch Griner, D.M.D.
• Jason Scott Grissom, D.M.D.
• Lindsey Morgan Groce
• Mark Leslie Grogan
• Larry J Grubbs, LCSW
• Rachel Gunalda

• General Practice Dentistry in Madison, MS
• Providers in Madison, MS by specialty
• General Practice Dentistry in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2008; 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.