Provider Demographics
NPI:1316164361
Name:JOHNNY GRINSPAN INC
Entity type:Organization
Organization Name:JOHNNY GRINSPAN INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:ROLANDO
Authorized Official - Last Name:GRINSPAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-465-9500
Mailing Address - Street 1:509 S MIRICK AVE
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-4433
Mailing Address - Country:US
Mailing Address - Phone:903-465-9500
Mailing Address - Fax:903-465-9500
Practice Address - Street 1:509 S MIRICK AVE
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4433
Practice Address - Country:US
Practice Address - Phone:903-465-9500
Practice Address - Fax:903-465-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20582122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty