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General NPI Number Information
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NPI Number | 1578248092
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Entity Type | Organization
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Legal Business Name | GRANT DMSO LLC
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 6288 E GRANT RD
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City | TUCSON
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State | AZ
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Zip | 85712-5831
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Country | US
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Telephone | 520-372-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 6288 E GRANT RD
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City | TUCSON
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State | AZ
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Zip | 85712-5831
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Country | US
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Telephone | 702-525-4500
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | BRANDON DHAENENS
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Credential |
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Telephone | 520-372-9999
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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 |
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License Number State |
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