Provider Demographics
NPI:1962527432
Name:GRANT, DOUGLAS H (DMD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:H
Last Name:GRANT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5047 COTTAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-4204
Mailing Address - Country:US
Mailing Address - Phone:251-660-8600
Mailing Address - Fax:251-665-0117
Practice Address - Street 1:5047 COTTAGE HILL RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-4204
Practice Address - Country:US
Practice Address - Phone:251-660-8600
Practice Address - Fax:251-665-0117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL45711223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry