Healthcare Provider Details

I. General information

NPI: 1225340698
Provider Name (Legal Business Name): GRANDPAS DENTAL CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 07/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 W 10600 S
SANDY UT
84070-4160
US

IV. Provider business mailing address

53 W 10600 S
SANDY UT
84070-4160
US

V. Phone/Fax

Practice location:
  • Phone: 801-576-1444
  • Fax: 801-576-1464
Mailing address:
  • Phone: 801-576-1444
  • Fax: 801-576-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JONAS MR FILHO
Title or Position: PRESIDENT
Credential:
Phone: 801-576-1444