Provider Demographics
NPI:1124281084
Name:GRANT&JOYNER DDS PA
Entity type:Organization
Organization Name:GRANT&JOYNER DDS PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:KENISHA
Authorized Official - Middle Name:LASHAE
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-339-3279
Mailing Address - Street 1:1005 TURNER MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27603-7995
Mailing Address - Country:US
Mailing Address - Phone:757-339-3279
Mailing Address - Fax:919-779-6682
Practice Address - Street 1:6250 ROGERS RD
Practice Address - Street 2:
Practice Address - City:ROLESVILLE
Practice Address - State:NC
Practice Address - Zip Code:27571
Practice Address - Country:US
Practice Address - Phone:757-339-3279
Practice Address - Fax:919-779-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC79821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty