Active NPI
Jack Grodner, DDS
- General Practice Dentistry
- Springfield, OH
National Provider Identifier
1932115011
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 15077
- Practice address
- 413 E Home Rd
Springfield, OH 45503-2708 - Phone
- (937) 390-3077
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | 15077 | OH | Primary |
Addresses
Primary practice location
413 E Home Rd
Springfield, OH 45503-2708
Mailing address
413 E Home Rd
Springfield, OH 45503-2708
Phone (937) 390-3077
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107461 | Other | OH | DORAL LOCATOR NUMBER |
| 310916628026 | Other | OH | CARESOURCE-MEDICAID |
| 0341446 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15077 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932115011",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "413 E HOME RD",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455032708",
"telephone_number": "937-390-3077"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "413 E HOME RD",
"city": "SPRINGFIELD",
"state": "OH",
"postal_code": "455032708",
"telephone_number": "937-390-3077"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRODNER",
"first_name": "JACK",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "15077",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DORAL LOCATOR NUMBER",
"identifier": "107461",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CARESOURCE-MEDICAID",
"identifier": "310916628026",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0341446",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.