Provider Demographics
NPI:1558108316
Name:GRANDINETTI, LIA ANGELICA (DDS)
Entity type:Individual
Prefix:
First Name:LIA
Middle Name:ANGELICA
Last Name:GRANDINETTI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11152 CYPRESS TREE PT APT 208
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7711
Mailing Address - Country:US
Mailing Address - Phone:224-938-2977
Mailing Address - Fax:
Practice Address - Street 1:905 W BAPTIST RD STE 100
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132
Practice Address - Country:US
Practice Address - Phone:719-481-5807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00206063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist