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General NPI Number Information
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NPI Number | 1831267673
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Entity Type | Organization
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Legal Business Name | GRIN AND BEAR IT DENTAL CLINIC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 08/04/2009
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Provider Practice Location Address
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Address Line | 9513 NE FOURTH PLAIN ROAD
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City | VANCOUVER
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State | WA
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Zip | 98662-6145
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Country | US
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Telephone | 360-254-5477
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Fax | 360-254-4881
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Provider Business Mailing Address
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Address Line | 9513 NE FOURTH PLAIN ROAD
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City | VANCOUVER
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State | WA
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Zip | 98662-6145
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Country | US
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Telephone | 360-254-5477
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Fax | 360-254-4881
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. NEIL A GRAY
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Credential | DMD
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Telephone | 360-254-5477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | UBI 602-099-728
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License Number State | WA
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