Provider Demographics
NPI:1336269703
Name:GRANT, JOHN BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRIAN
Last Name:GRANT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:JAMES
Other - Last Name:JARVIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:42000 6 MILE RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4336
Mailing Address - Country:US
Mailing Address - Phone:248-347-4250
Mailing Address - Fax:
Practice Address - Street 1:42000 6 MILE ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48168-4336
Practice Address - Country:US
Practice Address - Phone:248-347-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16072122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist