Healthcare Provider Details

I. General information

NPI: 1245446509
Provider Name (Legal Business Name): JOSEPH GRENN D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SPRUCE ST
SAN FRANCISCO CA
94118-2648
US

IV. Provider business mailing address

32 GREAT CIRCLE DRIVE
MILL VALLEY CA
94941-3217
US

V. Phone/Fax

Practice location:
  • Phone: 415-221-2900
  • Fax: 415-221-2950
Mailing address:
  • Phone: 415-221-2900
  • Fax: 415-221-2950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number22501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: