Healthcare Provider Details

I. General information

NPI: 1548053556
Provider Name (Legal Business Name): GRANT FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 6TH STREET
MEEKER CO
81641
US

IV. Provider business mailing address

PO BOX 1008
MEEKER CO
81641-1008
US

V. Phone/Fax

Practice location:
  • Phone: 970-878-5853
  • Fax: 970-878-8577
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: TREVOR GRANT
Title or Position: OWNER/ CEO
Credential: DDS
Phone: 970-623-1775