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General NPI Number Information
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NPI Number | 1144886565
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Entity Type | Individual
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Provider Name | GRANT JOSEPH GLEASON DMD
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Gender | Male
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Dates
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Enumeration Date | 05/10/2019
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Last Update Date | 09/30/2025
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Provider Practice Location Address
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Address Line | 3905 61ST ST
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City | WOODSIDE
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State | NY
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Zip | 11377-3566
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Country | US
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Telephone | 718-577-5069
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Fax |
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Provider Business Mailing Address
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Address Line | 296 CHERRY DR
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City | PASADENA
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State | CA
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Zip | 91105-2167
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Country | US
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Telephone | 617-669-9945
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS107432
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License Number State | CA
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