Provider Demographics
NPI:1194954537
Name:RICHARD GRANT DDS INC
Entity type:Organization
Organization Name:RICHARD GRANT DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:619-267-8905
Mailing Address - Street 1:2240 E PLAZA BLVD
Mailing Address - Street 2:M
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-5164
Mailing Address - Country:US
Mailing Address - Phone:619-267-8905
Mailing Address - Fax:
Practice Address - Street 1:2240 E PLAZA BLVD
Practice Address - Street 2:M
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-5164
Practice Address - Country:US
Practice Address - Phone:619-267-8905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51412261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental