Robert Brian Grippe, DMD
Individual provider Active NPI Dentist · Russell Springs, KY
NPI 1720197809 · NPPES record last updated Jul 27, 2007
Key facts
- NPI
- 1720197809
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 7471 (KY)
- Practice address
- 458 N Main St
Russell Springs, KY 42642 - Phone
- (270) 866-7222
- NPI assigned
- Aug 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160621002133 | KY | Order and Referring Only - Oral Surgery |
7315238441 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7471 | KY | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 7471 | KY | Yes |
| General Practice Dentistry | 1223G0001X | 7471 | KY |
Addresses
Primary practice location
458 N Main St
Russell Springs, KY 42642
Mailing address
PO Box 2249
Russell Springs, KY 42642-2249
Phone (270) 866-7222
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60000007 | Medicaid | KY | |
| 45002474 | Medicaid | KY |
Other names
- Dr. Brian Grippe
Other providers in Russell Springs, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.