Active NPI
Lion Grenader, DMD
- Dentist
- Winthrop Harbor, IL
National Provider Identifier
1720501380
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 019031298
- Practice address
- 644 Sheridan Rd # D
Winthrop Harbor, IL 60096-1350 - Phone
- (847) 872-5626
- NPI assigned
- Jul 25, 2017
- Last updated
- Mar 17, 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 | 019031298 | IL | Primary |
Addresses
Primary practice location
644 Sheridan Rd # D
Winthrop Harbor, IL 60096-1350
Mailing address
400 Penny LN
Grayslake, IL 60030-3737
Other practice location 1
417 E Il Route 173 Unit 113
Antioch, IL 60002-9407
Phone (847) 395-5550
Other practice location 2
10904 N Main St
Richmond, IL 60071-7717
Phone (815) 862-1112
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 |
|---|---|---|---|
| 019031298 | IL | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Edp of Illinois P.C | Past | Accepting new patients | |
| Miles Family Dental | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dentist
- Antioch, IL
- NPI 1851622187
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1500940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1720501380",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 PENNY LN",
"city": "GRAYSLAKE",
"state": "IL",
"postal_code": "600303737"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "644 SHERIDAN RD # D",
"city": "WINTHROP HARBOR",
"state": "IL",
"postal_code": "600961350",
"telephone_number": "847-872-5626"
}
],
"practiceLocations": [
{
"address_1": "417 E Il Route 173 Unit 113",
"address_purpose": "LOCATION",
"city": "Antioch",
"state": "IL",
"postal_code": "600029407",
"country_code": "US",
"telephone_number": "847-395-5550",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "10904 N Main St",
"address_purpose": "LOCATION",
"city": "Richmond",
"state": "IL",
"postal_code": "600717717",
"country_code": "US",
"telephone_number": "815-862-1112",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRENADER",
"first_name": "LION",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-25",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "IL",
"license": "019031298",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winthrop Harbor, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 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.