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General NPI Number Information
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NPI Number | 1356831325
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Entity Type | Individual
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Provider Name | GRANT SHANDLER D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 10/24/2023
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Provider Practice Location Address
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Address Line | 1322 W PARK WESTERN DR UNIT 216
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City | SAN PEDRO
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State | CA
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Zip | 90732-5014
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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 | 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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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DDS103449
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License Number State | CA
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