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General NPI Number Information
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NPI Number | 1013364736
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Entity Type | Individual
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Provider Name | ANDREW GRILLO D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/23/2016
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 600 SHIREWOOD LN
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City | MIDLAND
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State | MI
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Zip | 48642-7065
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Country | US
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Telephone | 989-600-8037
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Fax |
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Provider Business Mailing Address
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Address Line | 11323 WOLF DANCER PASS S # 101
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City | FISHERS
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State | IN
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Zip | 46037-4706
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Country | US
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Telephone | 989-600-8037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2901021823
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License Number State | MI
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