Healthcare Provider Details

I. General information

NPI: 1659650273
Provider Name (Legal Business Name): JOSEPH GRANT III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2011
Last Update Date: 08/31/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USCG BASE NATIONAL CAPITAL REGION 2703 MARTIN LUTHER KING JR. AVE SE USCG STOP 7201
WASHINGTON DC
20593
US

IV. Provider business mailing address

USCG BASE NATIONAL CAPITAL REGION 2703 MARTIN LUTHER KING JR AVE SE USCG STOP 7201
WASHINGTON DC
20593
US

V. Phone/Fax

Practice location:
  • Phone: 202-372-4100
  • Fax:
Mailing address:
  • Phone: 202-372-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN23239
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15886
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: