Provider Demographics
NPI:1588918908
Name:LAYTON, GRANT RONALD (DMD)
Entity type:Individual
Prefix:DR
First Name:GRANT
Middle Name:RONALD
Last Name:LAYTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC BOX 20130
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28542-0125
Mailing Address - Country:US
Mailing Address - Phone:910-451-1658
Mailing Address - Fax:
Practice Address - Street 1:153 A ST
Practice Address - Street 2:ATTENTION: CODE 00QM
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540
Practice Address - Country:US
Practice Address - Phone:910-451-1658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-07
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8311802-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist