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General NPI Number Information
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NPI Number | 1326477480
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Entity Type | Organization
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Legal Business Name | NIGEL D. GRANDISON, D.M.D.
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Dates
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Enumeration Date | 11/08/2013
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 10117 CLEARY BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-1066
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Country | US
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Telephone | 954-210-7488
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Fax |
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Provider Business Mailing Address
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Address Line | 10117 CLEARY BLVD
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City | PLANTATION
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State | FL
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Zip | 33324-1066
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Country | US
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Telephone | 954-210-7488
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NIGEL D GRANDISON
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Credential | D.M.D.
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Telephone | 954-210-7488
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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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