GRANDE DENTISTRY LLC

NPI: 1972166262 · RIO RANCHO, NM 87124 · General Practice Dentistry · NPI assigned 04/22/2019

Billing Flags · Automated signals — not evidence of fraud

Entity Proliferation

Authorized official GASKINS, FAITH controls 20+ related entities in our dataset. Read more

$8K

Total Medicaid Paid

373

Total Claims

371

Beneficiaries

Codes Billed

2019-09

First Month

2019-10

Last Month

Provider Details

Authorized Official	GASKINS, FAITH (DIRECTOR OF CREDENTIALING)
NPI Enumeration Date	04/22/2019

Other providers sharing the same authorized official: GASKINS, FAITH

Provider	City	State	Total Paid
CHRIS LARROW PLLC	LAWTON	OK	$16.57M
GERMANTOWN PEDIATRIC DENTAL & ORTHODONTIC CENTER, LLC	GERMANTOWN	MD	$3.35M
ROBSTOWN DENTAL PLLC	ROBSTOWN	TX	$2.84M
STAN KIDTASTIC DENTAL LLC	SAN TAN VALLEY	AZ	$2.22M
MESA KIDTASTIC DENTAL LLC	MESA	AZ	$1.61M
AVONDALE VALLEY DENTAL LLC	AVONDALE	AZ	$1.39M
PEPPERMINT DENTAL-MCKINNEY PLLC	MCKINNEY	TX	$1.35M
MESA VALLEY DENTAL LLC	MESA	AZ	$1.24M
MABANK FAMILY DENTISTRY PLLC	MABANK	TX	$753K
STASSNEY AUSTIN DENTAL PLLC	AUSTIN	TX	$659K
NORTHGLENN DENTISTRY AND ORTHODONTICS PLLC	NORTHGLENN	CO	$599K
GULFSIDE DENTAL BRIDGE CITY PLLC	BRIDGE CITY	TX	$569K
ARCHSTONE DENTAL PLLC	FORT WORTH	TX	$561K
GILBERT KIDTASTIC DENTAL LLC	GILBERT	AZ	$481K
RIVERSIDE AUSTIN DENTAL PLLC	AUSTIN	TX	$396K
DOVE FAMILY DENTISTRY OAKLAND PLLC	OAKLAND	TN	$391K
GILBERT VALLEY DENTAL LLC	GILBERT	AZ	$296K
WEST TENNESSEE DENTISTRY PLLC	JACKSON	TN	$287K
COPPERAS COVE DENTISTRY AND ORTHODONTICS PLLC	COPPERAS COVE	TX	$203K
EAST 51 AUSTIN DENTAL PLLC	AUSTIN	TX	$187K

Year	Claims	Total Paid
2019	373	$8K

Code	Description	Claims	Beneficiaries	Total Paid
D0274	Bitewings - four radiographic images	61	61	$2K
D1120	Prophylaxis - child	44	44	$1K
D1110	Prophylaxis - adult	24	24	$1K
D0150	Comprehensive oral evaluation - new or established patient	28	28	$959.00
D0220	Intraoral - periapical first radiographic image	78	76	$860.91
D1208	Topical application of fluoride, excluding varnish	38	38	$678.15
D0230	Intraoral - periapical each additional radiographic image	67	67	$596.31
D0120	Periodic oral evaluation - established patient	17	17	$378.59
D1206	Topical application of fluoride varnish	16	16	$288.00