MEDICARE: DR. EDWIN L GRAINGE 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
1	1223G0001X	General Practice Dentistry	8349	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B08349-1	OTHER	TX	CHIPS

General Provider Information

NPI Number	:	1326143728
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWIN L GRAINGE DDS

Provider Business Mailing Address
First Line	:	4242 E SOUTHCROSS
Second Line	:	#9
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3728
Country	:	US
Telephone Number	:	210-333-4421
Fax Number	:	210-333-4521

Provider Business Practice Location Address
First Line	:	4242 E SOUTHCROSS
Second Line	:	#9
City	:	SAN ANTONIO
State	:	TX
Zip	:	78222-3728
Country	:	US
Telephone Number	:	210-333-4421
Fax Number	:	210-333-4521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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