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General NPI Number Information
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NPI Number | 1164039293
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Entity Type | Individual
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Provider Name | ROMAN GRANT DDS
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Gender | Male
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Dates
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Enumeration Date | 09/23/2020
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Last Update Date | 07/11/2023
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Provider Practice Location Address
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Address Line | 703 S GOLIAD ST
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City | ROCKWALL
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State | TX
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Zip | 75087-3935
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Country | US
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Telephone | 972-771-9131
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Fax |
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Provider Business Mailing Address
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Address Line | 2616 TULIP DR
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City | RICHARDSON
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State | TX
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Zip | 75082-4244
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Country | US
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Telephone |
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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 | 36661
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 36661
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License Number State | TX
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