Provider Demographics
NPI:1063082048
Name:GRUNDY, JAMES (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:GRUNDY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 N COLE RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8658
Mailing Address - Country:US
Mailing Address - Phone:208-322-7478
Mailing Address - Fax:
Practice Address - Street 1:1166 N COLE RD STE B
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8658
Practice Address - Country:US
Practice Address - Phone:719-440-4178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-52811223G0001X
ID5281122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist