Individual provider Active NPI

Sara J Grady, DDS

  • Dentist
  • Sheboygan, WI
National Provider Identifier
1811730617
Registry record updated Dec 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
6001550 Issued in WI
Practice address
1721 Saemann Ave
Sheboygan, WI 53081-2342
Phone
(920) 783-6633
NPI assigned
Jun 18, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 6001550 WI Primary

Addresses

Primary practice location

1721 Saemann Ave
Sheboygan, WI 53081-2342

Mailing address

1721 Saemann Ave
Sheboygan, WI 53081-2342
Phone (920) 783-6633

Other names 1

  • Sara J Kroneck Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240807001465 WI Order and Referring Only - DentistPractitioner - Dentist 3870030950

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6001550WIMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1718668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764720000000",
    "number": "1811730617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1721 SAEMANN AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530812342",
            "telephone_number": "920-783-6633",
            "fax_number": "920-783-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1721 SAEMANN AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530812342",
            "telephone_number": "920-783-6633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRADY",
        "first_name": "SARA",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-18",
        "last_updated": "2025-12-03",
        "certification_date": "2025-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "WI",
            "license": "6001550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SARA",
            "last_name": "KRONECK",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.