Grant Blvd Dental PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0443351 Issued in NY

Legal business name

GRANT BLVD DENTAL PLLC

Practice address

1500 Grant Blvd
Syracuse, NY 13208

Phone

(315) 472-3414

NPI assigned

Mar 20, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Juan C Kassab, DMD

Title

Owner Dentist

Phone

(315) 472-3414

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Arun Balakumar, DDS

  • General Practice Dentistry
  • Syracuse, NY
  • NPI 1366597916
  NPD (past)

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1982729091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "118 S MAIN ST",
            "city": "CANASTOTA",
            "state": "NY",
            "postal_code": "130321234",
            "telephone_number": "315-697-9287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 GRANT BLVD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "13208",
            "telephone_number": "315-472-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT BLVD DENTAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KASSAB",
        "authorized_official_first_name": "JUAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "315-472-3414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "0443351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith Lynn Graham
• Klama Kobla Graham, M.D.
• Laura Elizabeth Graham, CRNA
• Laurie Ann Grainer-Cederquist, RN
• Kenneth M Graniero, RD
• Carrellyn Rhea Grant-Case, PT, DPT, NCS
• Alexis Haley Grant
• Breanna Elizabeth Grant, MSW
• Carroll Grant, PH.D.
• Jill Grant

• General Practice Dentistry in Syracuse, NY
• Providers in Syracuse, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.