Provider Demographics
NPI:1114768611
Name:GRANATOSKY PLLC
Entity type:Organization
Organization Name:GRANATOSKY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANATOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-431-1305
Mailing Address - Street 1:4001 COLBY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4991
Mailing Address - Country:US
Mailing Address - Phone:425-252-8919
Mailing Address - Fax:
Practice Address - Street 1:4001 COLBY AVE STE 1
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4991
Practice Address - Country:US
Practice Address - Phone:425-252-8919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental