=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073930764
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHERINE A. GRIGG DDS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2014
-----------------------------------------------------
Last Update Date | 03/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 598 OAK AVE
-----------------------------------------------------
City | SPRUCE PINE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28777-2728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-765-9002
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3589 CRESTWOOD DR
-----------------------------------------------------
City | MORGANTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28655-8788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-544-5085
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KATHERINE A GRIGG
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 828-443-6816
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 7837
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------