=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063566602
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN A. GRINALDI, DDS, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6757 ARAPAHO RD STE 753
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-385-3368
-----------------------------------------------------
Fax | 972-385-3379
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6757 ARAPAHO RD STE 753
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75248-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-385-3368
-----------------------------------------------------
Fax | 972-385-3379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. JOHN A GRINALDI
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 972-385-3368
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 10283
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------