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General NPI Number Information
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NPI Number | 1275271173
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Entity Type | Organization
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Legal Business Name | GRANT SHANDLER, DDS, INC.
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Dates
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Enumeration Date | 05/22/2022
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Last Update Date | 11/30/2022
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Provider Practice Location Address
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Address Line | 1111 PACIFIC COAST HWY STE 21
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City | HARBOR CITY
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State | CA
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Zip | 90710-3544
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Country | US
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Telephone | 323-688-6965
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Fax |
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Provider Business Mailing Address
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Address Line | 28625 S WESTERN AVE # 183
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-0810
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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 | PRESIDENT
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Name | DR. GRANT SHANDLER
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Credential | DDS
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Telephone | 323-688-6965
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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 |
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License Number State |
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