Healthcare Provider Details

I. General information

NPI: 1588918908
Provider Name (Legal Business Name): GRANT RONALD LAYTON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2012
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 FARENHOLT AVE
TAMUNING GU
96913-3106
US

IV. Provider business mailing address

PSC 455 BOX 208
FPO AP
96540-0003
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9269
  • Fax:
Mailing address:
  • Phone: 671-344-9269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8311802-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: