Jennifer Ellen Gray, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

019033143 Issued in IL

Practice address

801 Broadway
Chesterton, IN 46304-2230

Phone

(219) 763-8112

NPI assigned

Jun 8, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Ellen Niemzyk Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: jennifer.niemzyk.p1@direct.northshorehealth.nextgenshare.com

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1811564859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6050 STERLING CREEK RD",
            "city": "PORTAGE",
            "state": "IN",
            "postal_code": "463687752",
            "telephone_number": "219-763-8112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY",
            "city": "CHESTERTON",
            "state": "IN",
            "postal_code": "463042230",
            "telephone_number": "219-763-8112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRAY",
        "first_name": "JENNIFER",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-08",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019033143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "NIEMZYK",
            "middle_name": "ELLEN",
            "credential": "DDS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kassandra Glenn, RBT
• Globe Star, LLC
• Gerald E Gonnella, P.A.
• Emily R Gray, M.A. CF-SLP
• Jennifer Gray
• Laura Green
• Michelle L Green
• Brittany Lynn Griffith, MS, BCBA, LBA
• Cynthia Lynn Griffith, COTA
• Ann Grihalva, M.S. CCC-SLP

• Dentist in Chesterton, IN
• Providers in Chesterton, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.