Healthcare Provider Details

I. General information

NPI: 1508382474
Provider Name (Legal Business Name): ANDREW JON GRINSELL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WASHINGTON ST STE 103
WELLESLEY MA
02481-1706
US

IV. Provider business mailing address

1 WASHINGTON ST STE 103
WELLESLEY MA
02481-1706
US

V. Phone/Fax

Practice location:
  • Phone: 781-235-5700
  • Fax:
Mailing address:
  • Phone: 781-235-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN1857669
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: