Provider Demographics
NPI:1912914136
Name:GRANT, FORD T (DMD)
Entity type:Individual
Prefix:DR
First Name:FORD
Middle Name:T
Last Name:GRANT
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 1:100 HEALTH CENTER DR
Mailing Address - Street 2:ECU SODM CSLC
Mailing Address - City:AHOSKIE
Mailing Address - State:NC
Mailing Address - Zip Code:27910-8161
Mailing Address - Country:US
Mailing Address - Phone:252-737-7200
Mailing Address - Fax:252-209-8652
Practice Address - Street 1:100 HEALTH CENTER DR
Practice Address - Street 2:ECU SODM CSLC
Practice Address - City:AHOSKIE
Practice Address - State:NC
Practice Address - Zip Code:27910-8161
Practice Address - Country:US
Practice Address - Phone:252-737-7200
Practice Address - Fax:252-209-8652
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6223122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899335MMedicaid
NC899335MMedicaid