=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770409864
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WOODLAND DENTAL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2026
-----------------------------------------------------
Last Update Date | 06/24/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 PORT WASHINGTON RD
-----------------------------------------------------
City | GRAFTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53024-9835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-377-4130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1725 PORT WASHINGTON RD
-----------------------------------------------------
City | GRAFTON
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53024-9835
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-377-4130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. DAVID A GRISAR
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 262-377-4130
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------