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General NPI Number Information
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NPI Number | 1285011569
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Entity Type | Organization
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Legal Business Name | NATHAN J. GRANILLO, DDS, INC.
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Dates
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Enumeration Date | 05/06/2015
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Last Update Date | 05/06/2015
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Provider Practice Location Address
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Address Line | 1630 EL NITA LN
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City | HEMET
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State | CA
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Zip | 92544-4657
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Country | US
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Telephone | 951-652-2234
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Fax | 951-652-5894
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Provider Business Mailing Address
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Address Line | 1630 EL NITA LN
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City | HEMET
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State | CA
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Zip | 92544-4657
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Country | US
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Telephone | 951-652-2234
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Fax | 951-652-5894
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Authorized Official
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Title or Position | OWNER/ORTHODONTIST
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Name | DR. NATHAN JOSEPH GRANILLO
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Credential | DDS, MS
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Telephone | 951-652-2234
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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 | 56331
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 59012
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License Number State | CA
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