Provider Demographics
NPI:1063527695
Name:GRIGG, THEODORE ROBERTS (DMD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:ROBERTS
Last Name:GRIGG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5481 COLONY DR N
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-7189
Mailing Address - Country:US
Mailing Address - Phone:989-791-3636
Mailing Address - Fax:989-792-4002
Practice Address - Street 1:5481 COLONY DR N
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-7189
Practice Address - Country:US
Practice Address - Phone:989-791-3636
Practice Address - Fax:989-792-4002
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010185201223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics