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General NPI Number Information
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NPI Number | 1801187430
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Entity Type | Individual
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Provider Name | NATHAN JOSEPH GRANILLO D.D.S., MSD
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Gender | Male
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Dates
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Enumeration Date | 04/30/2011
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Last Update Date | 02/12/2014
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Provider Practice Location Address
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Address Line | 1630 EL NITA LN
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City | HEMET
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State | CA
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Zip | 92544-4657
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Country | US
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Telephone | 951-652-2234
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Fax | 951-652-5894
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Provider Business Mailing Address
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Address Line | 389 CYNTHIA CRES
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City | REDLANDS
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State | CA
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Zip | 92373-6836
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Country | US
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Telephone | 951-965-0841
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 59012
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License Number State | CA
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