Healthcare Provider Details

I. General information

NPI: 1366355471
Provider Name (Legal Business Name): GRANT P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10960 JEFFERSON BLVD
CULVER CITY CA
90230-4931
US

IV. Provider business mailing address

10960 JEFFERSON BLVD
CULVER CITY CA
90230-4931
US

V. Phone/Fax

Practice location:
  • Phone: 510-982-6179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: SEDERIC GRANT
Title or Position: OWNER
Credential: DDS
Phone: 510-982-6179