Healthcare Provider Details

I. General information

NPI: 1548616238
Provider Name (Legal Business Name): GRANT CHRISTIAN BURGDORF D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11797 NORTHFALL LN STE 702
ALPHARETTA GA
30009-7969
US

IV. Provider business mailing address

11797 NORTHFALL LN STE 702
ALPHARETTA GA
30009-7969
US

V. Phone/Fax

Practice location:
  • Phone: 770-622-1484
  • Fax: 770-676-6256
Mailing address:
  • Phone: 770-622-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN015915
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN015915
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: