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General NPI Number Information
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NPI Number | 1407229008
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Entity Type | Organization
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Legal Business Name | KEVIN J. GRANT D.D.S.,P.C.
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Dates
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Enumeration Date | 11/04/2015
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 8752A PARSONS BLVD
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City | JAMAICA
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State | NY
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Zip | 11432-3317
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Country | US
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Telephone | 718-523-7679
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Fax | 718-523-7689
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Provider Business Mailing Address
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Address Line | 8752A PARSONS BLVD
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City | JAMAICA
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State | NY
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Zip | 11432-3317
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Country | US
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Telephone | 718-523-7679
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Fax | 718-523-7689
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEVIN J GRANT
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Credential | D.D.S.
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Telephone | 718-523-7679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 044444
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License Number State | NY
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