Healthcare Provider Details

I. General information

NPI: 1770409864
Provider Name (Legal Business Name): WOODLAND DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PORT WASHINGTON RD
GRAFTON WI
53024-9835
US

IV. Provider business mailing address

1725 PORT WASHINGTON RD
GRAFTON WI
53024-9835
US

V. Phone/Fax

Practice location:
  • Phone: 262-377-4130
  • Fax:
Mailing address:
  • Phone: 262-377-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID A GRISAR
Title or Position: DENTIST/OWNER
Credential: DDS
Phone: 262-377-4130