Healthcare Provider Details

I. General information

NPI: 1538256110
Provider Name (Legal Business Name): JAMES WILLIAM GRANDER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORTH ASH
PEARSALL TX
78061
US

IV. Provider business mailing address

111 NORTH ASH
PEARSALL TX
78061
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-3333
  • Fax: 830-334-3307
Mailing address:
  • Phone: 830-334-3333
  • Fax: 830-334-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12441
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: