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NPI Code Detail

MEDICARE: NICOLE GRANATO DDS

MEDICARE: NICOLE GRANATO DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry36575TX

General Provider Information

NPI Number : 1083200158
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GRANATO DDS
Provider Business Mailing Address
First Line : 7272 WURZBACH RD STE 1004
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78240-4804
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7272 WURZBACH RD STE 1004
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78240-4804
Country : US
Telephone Number : 210-615-2319
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2020
Last Update Date : 12/14/2020

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Directions to “ NICOLE GRANATO DDS” Practice Location

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