Active NPI
Laura L Gradecki, D.D.S
- General Practice Dentistry
- Mequon, WI
National Provider Identifier
1790820538
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3633-015
- Practice address
- 10555 N Port Washington Rd
Suite 101
Mequon, WI 53092-5582 - Phone
- (262) 241-4460
- Fax
- (262) 241-4486
- NPI assigned
- Feb 20, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3633-015 | WI | Primary |
Addresses
Primary practice location
10555 N Port Washington Rd
Suite 101
Mequon, WI 53092-5582
Mailing address
1727 W El Rancho Dr
Mequon, WI 53092-5637
Phone (262) 241-0978
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20141119001498 | WI | Order and Referring Only - Oral Surgery | 7719109164 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3633-015 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171929600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1403481600000",
"number": "1790820538",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1727 W EL RANCHO DR",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925637",
"telephone_number": "262-241-0978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10555 N PORT WASHINGTON RD",
"address_2": "SUITE 101",
"city": "MEQUON",
"state": "WI",
"postal_code": "530925582",
"telephone_number": "262-241-4460",
"fax_number": "262-241-4486"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRADECKI",
"first_name": "LAURA",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "D.D.S",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-20",
"last_updated": "2014-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "3633-015",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mequon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.