Individual provider Active NPI

Grant S Pinney, DMD

  • General Practice Dentistry
  • Lake Mary, FL
National Provider Identifier
1770732695
Registry record updated Feb 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
DN18282 Issued in FL
Practice address
1325 S International Pkwy Ste 1201
Lake Mary, FL 32746-1406
Phone
(407) 862-3344
Fax
(407) 862-3374
NPI assigned
Sep 16, 2008
Last updated
Feb 16, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X DN18282 FL Primary

Addresses

Primary practice location

1325 S International Pkwy Ste 1201
Lake Mary, FL 32746-1406

Mailing address

1325 S International Pkwy Ste 1201
Lake Mary, FL 32746-1406
Phone (407) 862-3344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Opted out of Medicare
Yes, effective Apr 28, 2023 through Apr 28, 2027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
DN18282FLMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Coast Dental P.a. Dentist PastSince Jun 22, 2021 Accepting new patients
Coast Dental P.a. 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.

NPI Registry JSON

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

{
    "created_epoch": "1221523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1676505600000",
    "number": "1770732695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1325 S INTERNATIONAL PKWY STE 1201",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461406",
            "telephone_number": "407-862-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 S INTERNATIONAL PKWY STE 1201",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327461406",
            "telephone_number": "407-862-3344",
            "fax_number": "407-862-3374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PINNEY",
        "first_name": "GRANT",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-16",
        "last_updated": "2023-02-16",
        "certification_date": "2023-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18282",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Mary, FL

Sources for this page

Verify at the official NPI Registry.