Provider Demographics
NPI:1063621639
Name:L. PATRICK GRISANTI II, DDS, PA
Entity type:Organization
Organization Name:L. PATRICK GRISANTI II, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEONELLO
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:GRISANTI II
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-772-9505
Mailing Address - Street 1:2504 RIDGE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-2569
Mailing Address - Country:US
Mailing Address - Phone:972-772-9505
Mailing Address - Fax:972-722-7506
Practice Address - Street 1:2504 RIDGE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2569
Practice Address - Country:US
Practice Address - Phone:972-772-9505
Practice Address - Fax:972-722-7506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty