Healthcare Provider Details

I. General information

NPI: 1518548635
Provider Name (Legal Business Name): TREVOR PAUL GRANDGENETT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 PHILADELPHIA ST
AMES IA
50010-8700
US

IV. Provider business mailing address

2208 PHILADELPHIA ST
AMES IA
50010-8700
US

V. Phone/Fax

Practice location:
  • Phone: 515-956-3426
  • Fax: 515-956-3424
Mailing address:
  • Phone: 515-956-3426
  • Fax: 515-956-3424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS-10162
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: