Brandon Grantham, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

22297 Issued in TX

Practice address

1801 Patriot Circle
Copperas Cove, TX 76522

Phone

(254) 547-6453

Fax

(254) 547-7401

NPI assigned

Dec 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Brandon L Grantham DDS PA

  • Dental Clinic/Center
  • Copperas Cove, TX
  • NPI 1881063105

  Durable Medical Equipment & Medical Supplies

  NPD (past) Authorized official

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1540425600000",
    "number": "1790849248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1801 PATRIOT CIRCLE",
            "city": "COPPERAS COVE",
            "state": "TX",
            "postal_code": "76522",
            "telephone_number": "254-547-6453",
            "fax_number": "254-547-7401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 PATRIOT CIRCLE",
            "city": "COPPERAS COVE",
            "state": "TX",
            "postal_code": "76522",
            "telephone_number": "254-547-6453",
            "fax_number": "254-547-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRANTHAM",
        "first_name": "BRANDON",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2018-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "22297",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "1878704",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Eileen Gilligan, RN
• Kaniya Girard, LPC-ASSOCIATE
• David Y Go, MD
• Velma Christine Graham, MASSAGE THERAPIST
• Kevin J Grannes
• Jordon Greene, PHARMD
• Taylor P Greenhaw, PTA
• Rajan S Grewal, DPT
• Jack Griffin
• Kizzy Griffin

• Dentist in Copperas Cove, TX
• Providers in Copperas Cove, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2018; 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.

Verify at the official NPI Registry.