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General NPI Number Information
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NPI Number | 1285923599
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Entity Type | Organization
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Legal Business Name | PAUL G. GRANDSIRE, DMD, PLLC
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Dates
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Enumeration Date | 04/07/2011
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Last Update Date | 04/07/2011
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Provider Practice Location Address
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Address Line | 1415 BOSTON POST RD
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City | LARCHMONT
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State | NY
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Zip | 10538-3935
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Country | US
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Telephone | 914-834-1646
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Fax | 914-833-8335
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Provider Business Mailing Address
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Address Line | 26 LAKEVIEW AVENUE
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City | HARTSDALE
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State | NY
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Zip | 10530-2516
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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 | OWNER
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Name | DR. PAUL GRANDSIRE
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Credential | DMD
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Telephone | 914-834-1646
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 036185
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License Number State | NY
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