Healthcare Provider Details

I. General information

NPI: 1619048394
Provider Name (Legal Business Name): JAMES EDWARD GRANT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2837 EARLYSTOWN ROAD
CENTRE HALL PA
16828
US

IV. Provider business mailing address

2837 EARLYSTOWN ROAD P.O. BOX 197
CENTRE HALL PA
16828
US

V. Phone/Fax

Practice location:
  • Phone: 814-364-9000
  • Fax: 814-364-9626
Mailing address:
  • Phone: 814-364-9000
  • Fax: 814-364-9626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS018139L
License Number StatePA

VIII. Authorized Official

Name: DR. JAMES EDWARD GRANT
Title or Position: DENTIST
Credential: DMD
Phone: 814-364-9000